gms | German Medical Science

Objective: Coil migration and ist neurosurgical repair by aneurysm opening and material extraction with final clipping is reported in several reports and documented with intraoperative photographs. A case of a pericallosal aneurysm is presented with intraprocedural rupture combined with coil stretching of a sufficiently packed aneurysm sac. An emergency rescue-operation is described with succesfull extraction of the in situ stretched coil and clipping of the coiled aneurysm.

Methods: Angiographic documentation was made of the coiling procedure and the related complications of aneurysm rupture combined with stretching of the last coil i.e. impossibility to retrieve the material in fear of further bleeding. The coil was left in situ and an emergency operation was schedulded. The cathether sheet in the femoral angiographic access and the guiding catheter was left in situ harboring the still unreleased stretched coil. Radiolucent carbonic Mayfield clamp was applied and craniotomy performed. Aneurysm location was very fast and easily performed by using intraoperative fluoroscopic guidance due to the existing metallic material. Under visual controll the extraction of the streched coil through the catheter was successfully performed and a clip was applied. Immediate angiographic controll confirmed effective aneurysm occlusion.

Results: Incomplete endovascular methods or their complications could be solved by means of applying intraoperative fluoroscopy and complementary neurosurgical-neurointerventional measurements.

Conclusions: Supportive or complementary methods in aneurysm therapy by means of neurosurgical operations and endovascular interventions will be a future field besides the single stage methods of clipping or coiling. Due to the increasing application of the endovascular aneurysm therapy failed cases are likely to occur more often in the future. Successful solutions of such cases attribute to the handling of problematic situations.