gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Clipping versus coiling of ruptured intracranial aneurysms – outcome analysis and evaluation of complication rates between both methods

Clipping und Coiling bei rupturierten intrazerebralen Aneurysmen – Analyse über Outcome und Komplikationsrate beider Methoden

Meeting Abstract

  • corresponding author E. Kunze - Neurochirurgische Universitätsklinik Würzburg
  • G.H. Vince - Neurochirurgische Universitätsklinik Würzburg
  • M. Warmuth-Metz - Neuroradiologie, Universität Würzburg
  • A. Schütz - Neuroradiologie, Universität Würzburg
  • L. Solymosi - Neuroradiologie, Universität Würzburg
  • K. Roosen - Neurochirurgische Universitätsklinik Würzburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.06.04

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Kunze et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: In the last decade the endovascular management of aneurysms has developed to become the treatment of choice. Aim of the present study was to document the influence of the treatment modality (clipping versus endovascular treatment) on outcome and periprocedural complication rates.

Methods: From July 2000 to December 2004, 322 patients with subarachnoid hemorrhage were treated either by early clipping (EC) or endovascular Guglielmi detachable coils (GDCs) treatment (ET) after 3-D angiography in our department. The decision for clipping or coiling was made by neurosurgeons and neuroradiologists after angiography. There was no difference in the conservative therapy modalities ,such as HHH-therapy in both groups. 63 patients in the EC group were classified Hunt and Hess (HH) I and II, 58 patients HH III-V; 77 patients in ET group were graded HH I/II and 73 HH III-V. 95% of the aneurysms in the EC group were located in the anterior circulation, 33% of aneurysms treated by coiling (ET) were in the posterior circulation. 90% of MCA aneurysms were treated by clipping. The outcome was analysed according to the Glascow Outcome Score (GOS).

Results: The rate of general complications was similar in both groups, only dependent on initial HH grading.The incidence of vasospasm and infarction after treatment revealed no differences (periprocedural infarction in 8% and 10%). Over 80% of the ET aneurysms were coiled without a remnant neck in the 3 months angiographic follow-up. There were no significant differences in GOS in both groups (GOS 2/3: 25% EC and 26% ET, GOS 4/5: 67% EC and 64 % ET after 6 months. Only in patient group GOS 1 (deceased) was there a higher number of endovascular patients, which may be due to worse HH grades in this group.

Conclusions: In contrast to the results of the ISAT study, we could not indentify significant differences between coiled or clipped patient groups. We present the results of our interdisciplinary treatment concept in which to date, 45% of patients with aneurysmal SAH were clipped.