Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical and Radiogical Outcomes of Endovascular Detachable Coil Embolization in Paraclinoid Aneurysms : A 10-Year Experience

  • Jin, Sung-Chul (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kwon, Do-Hoon (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ahn, Jae-Sung (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kwun, Byung-Duk (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Song, Young (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Choi, Choong-Gon (Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • Published : 2009.01.28
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Abstract

Objective : Direct surgical clipping of paraclinoid aneurysms poses technical challenges to even very experienced neurosurgeons, making endovascular treatment an alternative treatment modality in many centers. We have therefore retrospectively evaluated the safety and efficacy of endovascular detachable coil embolization of paraclinoid aneurysms. Methods : From June 1997 to June 2007, 65 patients underwent endovascular detachable coiling for 67 paraclinoid aneurysms (of which 9 were ruptured and 58 were unruptured) in our institute. Their medical records, radiological images and readings, and operation records were reviewed retrospectively. Results : After the initial embolization procedure, complete occlusion was achieved in 29 (43.3%) of the aneurysms treated by endovascular detachable coiling. Six aneurysms required retreatment, with two each requiring one, two, or three additional endovascular procedures. Fifty-five (82.1%) aneurysms were measured by three-dimensional time of flight (TOF) magnetic resonance images (MRI) or transfemoral cerebral angiography (TFCA) at a mean follow-up of 29.7 months (range from 4 to 94 months), with 39 aneurysms (70.9%) showing complete occlusion. Thromboembolic events (3.8%) were the most frequent complication. Rupture did not occur during or after any of the procedures. According to the Glasgow Outcome Scale (GOS), 98.4% of the patients treated by coil embolization had a score of 4 or 5. Conclusion : Our results indicate that endovascular detachable coiling is a safe and effective treatment modality in paraclinoid aneurysms.

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References

  1. al-Rodhan NR, Piepgras DG, Sundt TM Jr : Transitional cavernous aneurysms of the internal carotid artery. Neurosurgery 33 : 993-996; discussion 997-998, 1993 https://doi.org/10.1227/00006123-199312000-00006
  2. Aldrich F : Anterior (dorsal) paraclinoid aneurysm : case report. Surg Neurol 35 : 374-376, 1991 https://doi.org/10.1016/0090-3019(91)90048-E
  3. Almeida GM, Shibata MK, Bianco E : Carotid-ophthalmic aneurysms. Surg Neurol 5 : 41-45, 1976
  4. Arnautovic KI, Al-Mefty O, Angtuaco E : A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms. Surg Neurol 50 : 504-518; discussion 518-520, 1998 https://doi.org/10.1016/S0090-3019(97)80415-6
  5. Batjer HH, Kopitnik TA, Giller CA, Samson DS : Surgery for paraclinoidalcarotid artery aneurysms. J Neurosurg 80 : 650-658, 1994 https://doi.org/10.3171/jns.1994.80.4.0650
  6. Bavinzski G, Killer M, Gruber A, Reinprecht A, Gross CE, Richling B : Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils: a 6-year experience. J Neurosurg 90 : 843-852, 1999 https://doi.org/10.3171/jns.1999.90.5.0843
  7. Bouthillier A, van Loveren HR, Keller JT : Segments of the internal carotid artery : a new classification. Neurosurgery 38 : 425-432; discussion 432-433, 1996 https://doi.org/10.1097/00006123-199603000-00001
  8. 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
  9. Byrne JV, Sohn MJ, Molyneux AJ, Chir B : Five-year experience in using coil embolization for ruptured intracranial aneurysms : outcomes and incidence of late rebleeding. J Neurosurg 90 : 656-663, 1999 https://doi.org/10.3171/jns.1999.90.4.0656
  10. Casasco AE, Aymard A, Gobin YP, Houdart E, Rogopoulos A, George B, et al : Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79 : 3-10, 1993 https://doi.org/10.3171/jns.1993.79.1.0003
  11. Cawley CM, Zipfel GJ, Day AL : Surgical treatment of paraclinoid andophthalmic aneurysms. Neurosurg Clin N Am 9 : 765-783, 1998
  12. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, et al : Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212 : 348-356, 1999 https://doi.org/10.1148/radiology.212.2.r99jl47348
  13. Day AL : Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72 : 677-691, 1990 https://doi.org/10.3171/jns.1990.72.5.0677
  14. Day AL : Clinicoanatomic features of supraclinoid aneurysms. Clin Neurosurg 36 : 256-274, 1990
  15. Drake CG, Vanderlinden RG, Amacher AL : Carotid-ophthalmic aneurysms. J Neurosurg 29 : 24-31, 1968 https://doi.org/10.3171/jns.1968.29.1.0024
  16. Eskridge JM, Song JK : Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils : results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 89 : 81-86, 1998 https://doi.org/10.3171/jns.1998.89.1.0081
  17. Ferguson GG, Drake CG : Carotid-ophthalmic aneurysms : the surgical management of those cases presenting with compression of the optic nerves and chiasm alone. Clin Neurosurg 27 : 263-307, 1980 https://doi.org/10.1093/neurosurgery/27.CN_suppl_1.263
  18. Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR : Endovascular occlusion of intracranial aneurysms with electrically detachable coils : correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 15 : 815-820, 1994
  19. Fox AJ, Vinuela F, Pelz DM, Peerless SJ, Ferguson GG, Drake CG, et al : Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66 : 40-46, 1987 https://doi.org/10.3171/jns.1987.66.1.0040
  20. Fox JL : Microsurgical treatment of ventral (paraclinoid) internal carotid artery aneurysms. Neurosurgery 22 : 32-39, 1988 https://doi.org/10.1227/00006123-198801000-00005
  21. Gelber BR, Sundt TM Jr : Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg 52 : 1-10, 1980 https://doi.org/10.3171/jns.1980.52.1.0001
  22. Guglielmi G, Vinuela F, Dion J, Duckwiler G : Electrothrombosis of saccular aneurysms via endovascular approach. Part 2 : Preliminary clinical experience. J Neurosurg 75 : 8-14, 1991 https://doi.org/10.3171/jns.1991.75.1.0008
  23. Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al : Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77 : 515-524, 1992 https://doi.org/10.3171/jns.1992.77.4.0515
  24. Guidetti B, La Torre E : Carotid-ophthalmic aneurysms. A series of 16 cases treated by direct approach. Acta Neurochir (Wien) 22 : 289-304, 1970 https://doi.org/10.1007/BF01402996
  25. Guidetti B, La Torre E : Management of carotid-ophthalmic aneurysms. J Neurosurg 42 : 438-442, 1975 https://doi.org/10.3171/jns.1975.42.4.0438
  26. Gurian JH, Vinuela F, Guglielmi G, Gobin YP, Duckwiler GR : Endovascular embolization of superior hypophyseal artery aneurysms. Neurosurgery 39 : 1150-1154; discussion 1154-1156, 1996 https://doi.org/10.1097/00006123-199612000-00016
  27. Heros RC, Nelson PB, Ojemann RG, Crowell RM, DeBrun G : Large and giant paraclinoid aneurysms : surgical techniques, complications, and results. Neurosurgery 12 : 153-163, 1983 https://doi.org/10.1227/00006123-198302000-00004
  28. Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS : Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 48 : 78-89 ; discussion 89-90, 2001 https://doi.org/10.1097/00006123-200101000-00014
  29. Hopkins LN, Grand W : Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Neurosurgery 5 : 21-31, 1979 https://doi.org/10.1227/00006123-197907010-00004
  30. Horowitz MB, Levy E, Kassam A, Purdy PD : Endovascular therapy for intracranial aneurysms : a historical and present status review. Surg Neurol 57 : 147-158; discussion 159, 2002 https://doi.org/10.1016/S0090-3019(01)00701-7
  31. Hosobuchi Y : Direct surgical treatment of giant intracranial aneurysms. J Neurosurg 51 : 743-756, 1979 https://doi.org/10.3171/jns.1979.51.6.0743
  32. Kattner KA, Bailes J, Fukushima T : Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery : report of 29 cases. Surg Neurol 49 : 471- 480, 1998 https://doi.org/10.1016/S0090-3019(97)00374-1
  33. Kobayashi S, Kyoshima K, Gibo H, Hegde SA, Takemae T, Sugita K : Carotid cave aneurysms of the internal carotid artery. J Neurosurg 70 : 216-221, 1989 https://doi.org/10.3171/jns.1989.70.2.0216
  34. Korosue K, Heros RC : 'Subclinoid' carotid aneurysm with erosion of the anterior clinoid process and fatal intraoperative rupture. Neurosurgery 31 : 356-359; discussion 359-360, 1992 https://doi.org/10.1227/00006123-199208000-00024
  35. Kothandaram P, Dawson BH, Kruyt RC : Carotid-ophthalmic aneurysms. A study of 19 patients. J Neurosurg 34 : 544-548, 1971 https://doi.org/10.3171/jns.1971.34.4.0544
  36. 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
  37. Locksley HB : Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25 : 219-239, 1966 https://doi.org/10.3171/jns.1966.25.2.0219
  38. McDougall CG, Halbach VV, Dowd CF, Higashida RT, Larsen DW, Hieshima GB : Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84 : 393-399, 1996 https://doi.org/10.3171/jns.1996.84.3.0393
  39. 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 randomised trial. Lancet 360 : 1267- 1274, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  40. Murayama Y, Vinuela F, Duckwiler GR, Gobin YP, Guglielmi G : Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90 : 207-214, 1999 https://doi.org/10.3171/jns.1999.90.2.0207
  41. Nishioka H: Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section VII. I. Evaluation of the conservative management of ruptured intracranial aneurysms. J Neurosurg 25 : 574-592, 1966 https://doi.org/10.3171/jns.1966.25.5.0574
  42. Nutik S : Carotid paraclinoid aneurysms with intradural origin and intracavernous location. J Neurosurg 48 : 526-533, 1978 https://doi.org/10.3171/jns.1978.48.4.0526
  43. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al : Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34 : 1398-1403, 2003 https://doi.org/10.1161/01.STR.0000073841.88563.E9
  44. Raymond J, Roy D : Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41 : 1235-1245; discussion 1245-1246, 1997 https://doi.org/10.1097/00006123-199712000-00002
  45. Roy D, Milot G, Raymond J : Endovascular treatment of unruptured aneurysms. Stroke 32 : 1998-2004, 2001 https://doi.org/10.1161/hs0901.095600
  46. Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L'Esperance G : Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 18 : 1207-1215, 1997
  47. Sengupta RP, Gryspeerdt GL, Hankinson J : Carotid-ophthalmic aneurysms. J Neurol Neurosurg Psychiatry 39 : 837-853, 1976 https://doi.org/10.1136/jnnp.39.9.837
  48. Solander S, Ulhoa A, Vinuela F, Duckwiler GR, Gobin YP, Martin NA, et al : Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg 90 : 857-864, 1999
  49. Spetzler RF, Schuster H, Roski RA : Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg 53 : 22-27, 1980 https://doi.org/10.3171/jns.1980.53.1.0022
  50. Sundt TM Jr, Piepgras DG : Surgical approach to giant intracranial aneurysms. Operative experience with 80 cases. J Neurosurg 51 : 731- 742, 1979 https://doi.org/10.3171/jns.1979.51.6.0731
  51. Thornton J, Aletich VA, Debrun GM, Alazzaz A, Misra M, Charbel F, et al : Endovascular treatment of paraclinoid aneurysms. Surg Neurol 54 : 288-299, 2000 https://doi.org/10.1016/S0090-3019(00)00313-X
  52. Thurel C, Rey A, Thiebaut JB, Chai N, Houdart R : [Carotidoophthalmic aneurysms]. Neurochirurgie 20 : 25-39, 1974
  53. Yasargil MG, Fox JL : The microsurgical approach to intracranial aneurysms. Surg Neurol 3 : 7-14, 1975
  54. Yasargil MG, Gasser JC, Hodosh RM, Rankin TV : Carotidophthalmic aneurysms : direct microsurgical approach. Surg Neurol 8 : 155-165, 1977

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