Microsurgical Management of Intracranial Aneurysms After Failed Flow Diversion.


Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Feb 2020
Historique:
received: 10 06 2019
revised: 15 08 2019
accepted: 16 08 2019
pubmed: 31 8 2019
medline: 7 3 2020
entrez: 31 8 2019
Statut: ppublish

Résumé

Flow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases. We present a multicenter series of 13 aneurysms for which FD failed and that were subsequently treated with open surgery. We also present a review of the reported data regarding operative management of aneurysms after unsuccessful FD. Twelve patients with 13 aneurysms were included in the present study. All 12 patients had undergone surgery after FD because of persistent aneurysm filling, mass effect, or aneurysm rupture. The patients underwent aneurysm clipping and parent vessel reconstruction, decompression of the aneurysm mass, occlusion of proximal flow to the aneurysm, or aneurysm trapping with or without extracranial-intracranial artery bypass. Aneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise.

Sections du résumé

BACKGROUND BACKGROUND
Flow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases.
METHODS METHODS
We present a multicenter series of 13 aneurysms for which FD failed and that were subsequently treated with open surgery. We also present a review of the reported data regarding operative management of aneurysms after unsuccessful FD.
RESULTS RESULTS
Twelve patients with 13 aneurysms were included in the present study. All 12 patients had undergone surgery after FD because of persistent aneurysm filling, mass effect, or aneurysm rupture. The patients underwent aneurysm clipping and parent vessel reconstruction, decompression of the aneurysm mass, occlusion of proximal flow to the aneurysm, or aneurysm trapping with or without extracranial-intracranial artery bypass.
CONCLUSIONS CONCLUSIONS
Aneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise.

Identifiants

pubmed: 31470147
pii: S1878-8750(19)32277-6
doi: 10.1016/j.wneu.2019.08.121
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e16-e28

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Nnenna Mbabuike (N)

Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA.

Sophia F Shakur (SF)

Department of Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.

Kelly Gassie (K)

Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA.

Visish Srinivasan (V)

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

Justin Mascitelli (J)

Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.

Adib Abla (A)

Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.

Edward Duckworth (E)

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

Peter Kan (P)

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

Georgios A Zenonos (GA)

Department of Neurosurgery, University of Miami, Miami, Florida, USA.

Clemens Schirmer (C)

Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA.

Fady T Charbel (FT)

Department of Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.

Evandro de Olivera (E)

Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA; Institute of Neurological Sciences, São Paolo, São Paolo, Brazil.

Jacques J Morcos (JJ)

Department of Neurosurgery, University of Miami, Miami, Florida, USA.

Michael Lawton (M)

Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.

Rabih G Tawk (RG)

Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA. Electronic address: Tawk.rabih@mayo.edu.

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