gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Clipping after coiling – neurosurgical management of cerebral aneurysms previously treated with endovascular therapy

Meeting Abstract

  • R. Brucker - Neurochirurgische Klinik, Klinikum Ingolstadt
  • D. Vorwerk - Institut für diagnostische und interventionelle Radiologie, Klinikum Ingolstadt
  • M. Schmutzler - Neurochirurgische Klinik, Klinikum Ingolstadt
  • S. Asgari - Neurochirurgische Klinik, Klinikum Ingolstadt

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.11.08

doi: 10.3205/11dgnc085, urn:nbn:de:0183-11dgnc0854

Published: April 28, 2011

© 2011 Brucker 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: With the growing number of interventionally treated cerebral aneurysms with detachable coils and the unavoidable risk of neck remnant and coil compaction, the frequency of Guglielmi detachable coils (GDC)-packed aneurysms requiring neurosurgical management is increasing. We present a consecutive series of 11 patients who underwent microsurgical clipping after primary coil embolization with GDC.

Methods: This retrospective analysis includes 11 patients who underwent previous GDC packing of their cerebral aneurysms. In all of these patients treated between June 2009 and December 2010, microsurgical clip ligation was necessary because of enlargement of the initial neck remnant or coil compaction with reperfusion of the aneurysm. The age of the patients ranged between 41 and 68 years. (mean 49 years). Clinical postoperative outcome was evaluated using the Glasgow Outcome Scale. The post-coiling and follow-up angiographic findings were categorized as follows: neck remnant with recanalization (n=2) and coil compaction (n=9). All aneurysms were located in the anterior circulation; internal carotid artery (n=2), middle cerebral artery (n=3), anterior communicating artery (n=5) and pericallosal artery (n=1). In all patients, intraoperative monitoring of somatosensory evoked potentials and microscope-integrated near-infrared indocyanine green videoangiography were performed. The patients were followed angiographically and clinically.

Results: In our study all aneurysms in 11 patients were able to be successfully clipped with preservation of the parent vessel and confirmed angiographically. No hemorrhage occurred during the surgical clipping and removal of the coils was not necessary in all cases. All patients had an excellent neurological outcome with a GOS of 5. In 3 cases with residual aneurysm configuration under 4 mm, we noted a hot spot in the neck area.

Conclusions: In the literature, annual rebleeding rates of previously coiled aneurysms with neck remnants were estimated at about 0.8% per patient and year. Surgical clipping is a safe alternative approach for reperfused aneurysms that cannot be treated again interventionally for various reasons.