Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Combined Endovascular and Microsurgical Procedures as Complementary Approaches in the Treatment of a Single Intracranial Aneurysm

  • Lim, Yong-Cheol (Department of Neurosurgery School of Medicine Ajou University) ;
  • Shin, Yong-Sam (Department of Neurosurgery School of Medicine Ajou University) ;
  • Chung, Joon-Ho (Department of Neurosurgery School of Medicine Ajou University)
  • Published : 2008.01.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Both endovascular coil embolization and microsurgical clipping are now firmly established as treatment options for the management of cerebral aneurysms. Moreover, they are sometimes used as complementary approaches each other. This study retrospectively analyzed our experience with endovascular and microsurgical procedures as complementary approaches in treating a single aneurysm. Methods : Nineteen patients with intracranial aneurysm were managed with both endovascular and microsurgical treatments. All of the aneurysms were located in the anterior circulation. Eighteen patients presented with SAH, and 14 aneurysms had diameters of less than 10 mm, and five had diameters of 10-25 mm. Results : Thirteen of the 19 patients were initially treated with endovascular coil embolization, followed by microsurgical management. Of the 13 patients, 9 patients had intraprocedural complications during coil embolization (intraprocedural rupture, coil protrusion, coil migration), rebleeding with regrowth of aneurysm in two patients, residual sac in one patient, and coil compaction in one patient. Six patients who had undergone microsurgical clipping were followed by coil embolization because of a residual aneurysm sac in four patients, and regrowth in two patients. Conclusion : In intracranial aneurysms involving procedural endovascular complications or incomplete coil embolization and failed microsurgical clipping, because of anatomical and/or technical difficulties, the combined and complementary therapy with endovascular coiling and microsurgical clipping are valuable in providing the best outcome.

Keywords

References

  1. Bavinzski G, Talazoglu V, Killer M, Gruber A, Richling B, al-Shameri R : Coiling of recurrent and residual cerebral aneurysms after unsuccessful clipping. Minim Invasive Neurosurg 42 : 22-26, 1999 https://doi.org/10.1055/s-2008-1053363
  2. Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A : Treatment of intracranial aneurysms by embolization with coils : A systematic review. Stroke 30 : 470-476, 1999 https://doi.org/10.1161/01.STR.30.2.470
  3. Civit T, Auque J, Marchal JC, Bracard S, Picard L, Hepner H : Aneurysm clipping after endovascular treatment with coils : a report of eight patients. Neurosurgery 38 : 955-961, 1996 https://doi.org/10.1097/00006123-199605000-00021
  4. Cognard C, Weill A, Castaings L, Rey A, Moret J : Intracranial berry aneurysms : angiographic and clinical results after endovascular treatment. Radiology 206 : 499-510, 1998 https://doi.org/10.1148/radiology.206.2.9457205
  5. Deshmukh VR, Klopfenstein J, Albuquerque FC, Kim LJ, Spetzler RF : Surgical management of distal coil migration and arterial perforation after attempted coil embolization of a ruptured ophthalmic artery aneurysm : technical case report. Neurosurgery 58 Operative Neurosurgery Supplement 2 : ONS-E379, 2006
  6. Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F : Selection of cerebral aneurysms for treatment using Guglielmi detachable coils : the preliminary University of Illinois at Chicago experience. Neurosurgery 43 : 1281-1295, 1998 https://doi.org/10.1097/00006123-199812000-00011
  7. Dinc H, Kuzeyli K, Kosucu P, Sari A, Cekirqe S : Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms. Neuroradiology 48 : 269-272, 2006 https://doi.org/10.1007/s00234-006-0051-x
  8. Doerfler A, Wanke I, Egelhof T, Dietrich U, Asqari S, Stolke D, et al : Aneurysmal rupture during embolization with Guglielmi detachable coils : causes, management, and outcome. AJNR Am J Neuroradiol 22 : 1825-1832, 2001
  9. Drake CG, Friedman AH, Peerless SJ : Failed aneurysm surgery : reoperation in 115 cases. J Neurosurg 61 : 848-856, 1984 https://doi.org/10.3171/jns.1984.61.5.0848
  10. Feuerberg I, Lindquist C, Lindqvist M, Steiner L : Natural history of postoperative aneurysm rests. J Neurosurg 66 : 30-34, 1987 https://doi.org/10.3171/jns.1987.66.1.0030
  11. Fraser KW, Halbach VV, Teitelbaum GP, Smith TP, Higashida RT, Dowd CF, et al : Endovascular platinum coil embolization of incompletely surgically clipped cerebral aneurysms. Surg Neurol 41 : 4-8, 1994 https://doi.org/10.1016/0090-3019(94)90200-3
  12. Giannotta SL, Litofsky NS : Reoperative management of intracranial aneurysms. J Neurosurg 83 : 387-393, 1995 https://doi.org/10.3171/jns.1995.83.3.0387
  13. Gurian JH, Martin NA, King WA, Duckwiler GR, Guglielmi G, Vinuela F : Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 83 : 843-853, 1995 https://doi.org/10.3171/jns.1995.83.5.0843
  14. Kuether TA, Nesbit GM, Barnwell SL : Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils : a single-center experience. Neurosurgery 43 : 1016-1025, 1998 https://doi.org/10.1097/00006123-199811000-00007
  15. Lavine SD, Larsen DW, Giannotta SL, Teitelbaum GP : Parent vessel Guglielmi detachable coil herniation during wide-necked aneurysm embolization : treatment with intracranial stent placement : two technical case reports. Neurosurgery 46 : 1013-1017, 2000 https://doi.org/10.1097/00006123-200004000-00051
  16. Leber KA, Klein GE, Trummer M, Eder HG : Intracranial aneurysms : a review of endovascular and surgical treatment in 248 patients. Minim Invasive Neurosurg 41 : 81-85, 1998 https://doi.org/10.1055/s-2008-1052022
  17. Lin T, Fox AJ, Drake CG : Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70 : 556-560, 1989 https://doi.org/10.3171/jns.1989.70.4.0556
  18. Lot G, Houdart E, Cophignon J, Casasco A, George B : Combined management of intracranial aneurysms by surgical and endovascular treatment : modalities and results from a series of 395 cases. Acta Neurochir (Wien) 141 : 557-562, 1999 https://doi.org/10.1007/s007010050343
  19. Marks MP, Steinberg GK, Lane B : Combined use of endovascular coils and surgical clipping for intracranial aneurysms. AJNR Am J Neuroradiol 16 : 15-18, 1995
  20. Martin NA : The combination of endovascular and surgical techniques for the treatment of intracranial aneurysms. Neurosurg Clin N Am 9 : 897-916, 1998
  21. McDougall CG, Halbach VV, Dowd CF, Higashida RT, Larsen DW, Hieshima GB : Causes and management of aneurysmal hemorrhage occurring during embolization with Guglielmi detachable coils. J Neurosurg 89 : 87-92, 1998 https://doi.org/10.3171/jns.1998.89.1.0087
  22. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomized trial. Lancet 360 : 1267-1274, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  23. Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W : Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils : Analysis of midterm angiographic and clinical outcomes. Stroke 33 : 210-217, 2002 https://doi.org/10.1161/hs0102.100486
  24. Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, et al : Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26 : 506-514, 2005
  25. Phatouros CC, McConachie NS, Jaspan T : Post-procedure migration of Guglielmi detachable coils and mechanical detachable spirals. Neuroradiology 41 : 324-327, 1999 https://doi.org/10.1007/s002340050757
  26. Ricolfi F, Le Guerinel C, Blustajn J, Combes C, Bruqieres P, Melon E, et al : Rupture during treatment of recently ruptured aneurysms with Guglielmi electrodetachable coils. AJNR Am J Neuroradiol 19 : 1653-1658, 1998
  27. Short JG, Marx WF, Lanzino G, Ellegala DB, Kassell NF : Surgical salvage of microcatheter-induced aneurysm perforation during coil embolization. AJNR Am J Neuroradiol 23 : 682-685, 2002
  28. Sindou M, Acevedo JC, Turjman F : Aneurysmal remnants after microsurgical clipping : classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms). Acta Neurochir (Wien) 140 : 1153-1159, 1998 https://doi.org/10.1007/s007010050230
  29. Sluzewski M, Bosch JA, van Rooij WJ, Nijssen PC, Wijnalda D : Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils : incidence, outcome, and risk factors. J Neurosurg 94 : 238-240, 2001 https://doi.org/10.3171/jns.2001.94.2.0238
  30. Sugiu K, Martin JB, Jean B, Rufenacht DA : Rescue balloon procedure for an emergency situation during coil embolization for cerebral anerusyms. technical note. J Neurosurg 96 : 373-376, 2002 https://doi.org/10.3171/jns.2002.96.2.0373
  31. Thielen KR, Nichols DA, Fulgham JR, Piepgras DG : Endovascular treatment of cerebral aneurysms following incomplete clipping. J Neurosurg 87 : 184-189, 1997 https://doi.org/10.3171/jns.1997.87.2.0184
  32. Thornton J, Bashir Q, Aletich VA, Debrun GM, Ausman JI, Charbel FT : What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46 : 1294-1300, 2000 https://doi.org/10.1097/00006123-200006000-00003
  33. Thornton J, Dovey Z, Alazzaz A, Misra M, Aletich VA, Debrun GM, et al : Surgery following endovascular coil of intracranial aneurysms. Surg Neurol 54 : 352-360, 2000 https://doi.org/10.1016/S0090-3019(00)00337-2
  34. Willinsky R, terBrugge K : Use of a second microcatheter in the management of a perforation during endovascular treatment of a cerebral aneurysm. AJNR Am J Neuroradiol 21 : 1537-1539, 2001

Cited by

  1. Intraprocedural Aneurysmal Rupture during Coil Embolization of Brain Aneurysms: Role of Balloon-Assisted Coiling vol.33, pp.10, 2012, https://doi.org/10.3174/ajnr.a3061
  2. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms vol.4, pp.None, 2008, https://doi.org/10.3389/fneur.2013.00108
  3. Single-session Coil Embolization of Multiple Intracranial Aneurysms vol.15, pp.3, 2008, https://doi.org/10.7461/jcen.2013.15.3.184