Article
Combined treatment of intracranial aneurysms by endovascular coiling and microsurgical clipping as an interdisciplinary approach
Kombinierte Behandlung intrakranieller Aneurysmen mittels Coiling und Clipping
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Published: | May 30, 2008 |
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Outline
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Objective: To present a consecutive series of patients treated with both clipping and coiling in a complementary combined endovascular and microsurgical approach.
Methods: We analyzed 36 consecutive patients with 50 aneurysms, who were treated by clipping and coiling in a total of 3 specific groups: clipping after attempted or incomplete coiling (5 anerysms, 10%), coiling after attempted or incomplete clipping (4 aneurysms, 8%) and multiple aneurysms treated with both clipping and coiling (41 aneurysms, 82%) according to our intracranial aneurysms database from 1999 to 2007.
Results: 34 patients (95%) first presented with SAH, mean WFNS1. The anatomic distribution in a total 50 aneurysms was as follows: 40 aneurysms (80%) in the anterior circulation, 10 aneurysms (20%) in the posterior circulation. Mean aneurysm size was 6.2mm. All aneurysms of the first 2 groups were regarded as complex. The mean age were 46.78 years. Complete aneurysm occlusion was achieved in 90% (aneurysm). 77,5% achieved a favourable outcome (mRs 0-2), 22,5% a poor outcome. 2 patients died: 1 patient rebled and died after intended incomplete aneurysm occlusion, another due to severe cerebral vasospasm.
Conclusions: Especially for complex intracranial aneurysms or patients with multiple cerebral aneurysms, the interdisciplinary conference between experienced neurosurgeons and interventional neuroradiologists in a neurovascular center is mandatory for the best results. Combined microsurgical clipping and endovascular coiling can be the treatment option of choice in selected patients.