gms | German Medical Science

Objective: Intracranial aneurysms are incrementally found prior to rupture events and deleterious subarachnoid haemorrhage by means of ameliorated diagnostic magnetic resonance imaging and computed tomography of the neurocranium. The relatively growing number of innocent, multiple and recurrent aneurysms, after initially successful occlusion, requires deliberate treatment strategies and necessitates for both, neurointerventionalists and neurosurgeons, to tweak occlusion of the aneurysms in an interdisciplinary effort. The present study was conducted to condense essential strategies from a single neurovascular centre with respect to the initial presentation of the aneurysms, and the necessity of procedural changes in individual patients.

Methods: A total of 325 consecutive patients treated for intracranial aneurysms at our centre were included in this retrospective study from September 2008 until December 2010. The medical charts and radiological images were analysed for clinical presentation of the aneurysms, multiplicity and treatment pathways.

Results: 325 patients with a total of 492 aneurysms underwent occlusion of their symptomatic aneurysm. 136 (41.8%) patients were considered for surgical treatment of their aneurysm, 189 (58.2%) underwent coil embolization. Subgroup analysis of aneurysmal subarachnoid haemorrhages identified 137 patients of whom 43.8% were clipped and 56.2% were coiled. Clipping dominated in aneurysms of the middle cerebral artery (88), whereas the aneurysms of the internal carotid artery and anterior communicating artery (114) were preferably treated endovascular. Posterior circulation aneurysms were almost exclusively treated interventionally. In 98 patients (30.2%), multiple aneurysms (range 2–5 aneurysms/individuum) were found by digital subtraction angiography. Twelve patients with recurrent aneurysms after initial treatment by clip or coil were considered for the respective other occlusion technique (previously clip to coil, and vice versa) during the study period.

Conclusions: From our data, we suggest that the successful occlusion of intracranial aneurysms should be tailored individually to every patient by an interdisciplinary balanced treatment approach including both, neurointerventionalists and neurosurgeons. Especially multiple and recurrent aneurysms require a deliberate treatment. The consequent interdisciplinary pondering of the optimal strategy helps to achieve the occlusion of such delicate aneurysms.