Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization - a quest for the ultimate therapy.
Adult
Aged
Aged, 80 and over
Aortic Dissection
/ diagnostic imaging
Blood Vessel Prosthesis
/ trends
Embolization, Therapeutic
/ methods
Endovascular Procedures
/ methods
Female
Humans
Intracranial Aneurysm
/ diagnostic imaging
Male
Microsurgery
/ methods
Middle Aged
Neurosurgical Procedures
/ methods
Recurrence
Reoperation
/ methods
Retrospective Studies
Treatment Outcome
Aneurysm recurrence
Bypass
Endovascular treatment
Intracranial aneurysm
Microsurgical clipping
Residual aneurysm
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
19
11
2019
accepted:
17
03
2020
revised:
12
03
2020
pubmed:
27
3
2020
medline:
16
6
2021
entrez:
27
3
2020
Statut:
ppublish
Résumé
The long-term stability of coil embolization (CE) of complex intracranial aneurysms (CIAs) is fraught with high rates of recanalization. Surgery of precoiled CIAs, however, deviates from a common straightforward procedure, demanding sophisticated strategies. To shed light on the scope and limitations of microsurgical re-treatment, we present our experiences with precoiled CIAs. We retrospectively analysed a consecutive series of 12 patients with precoiled CIAs treated microsurgically over a 5-year period, and provide a critical juxtaposition with the literature. Five aneurysms were located in the posterior circulation, 8 were large-giant sized, 5 were calcified/thrombosed. One presented as a dissecting-fusiform aneurysm, 9 ranked among wide neck aneurysms. Eight lesions were excluded by neck clipping (5 necessitating coil extraction); 1 requiring adjunct CE. The dissecting-fusiform aneurysm was resected with reconstruction of the parent artery using a radial artery graft. Three lesions were treated with flow alteration (parent artery occlusion under bypass protection). Mean interval coiling-surgery was 4.6 years (range 0.5-12 years). Overall, 10 aneurysms were successfully excluded; 2 lesions treated with flow alteration displayed partial thrombosis, progressing over time. Outcome was good in 8 and poor in 4 patients (2 experiencing delayed neurological morbidity), and mean follow-up was 24.3 months. No mortality was encountered. Microsurgery as a last resort for precoiled CIAs can provide-in a majority of cases-a definitive therapy with good outcome. Since repeat coiling increases the complexity of later surgical treatment, we recommend for this subgroup of aneurysms a critical evaluation of CE as an option for re-treatment.
Identifiants
pubmed: 32212048
doi: 10.1007/s10143-020-01290-7
pii: 10.1007/s10143-020-01290-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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