Article
Surgical clipping of previously coiled intracranial aneurysms
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Authors
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Guilherme R. Montibeller
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany
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Friedrich Götz
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Germany
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Joachim K. Krauss
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany
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Makoto Nakamura
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany
| Published: | September 16, 2010 |
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Outline
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Objective: Endovascular coiling techniques for the treatment of intracranial aneurysms as an alternative option for surgical clipping have rapidly developed in the past few years, however their side effects and new problems also become more obvious. A distinct problem after endovascular coiling is the management of a residual aneurysm neck due to incomplete coiling, compaction of coils or regrowth of the aneurysm. Treatment options in this situation include surgical clipping, re-coiling, stent implantation or observation. We present twelve patients who underwent surgical clipping of previously coiled intracranial aneurysms and discuss the indication for surgery in this particular group of patients.
Methods: From June 2006 to May 2010, twelve patients underwent surgical clipping of residual or recurrent aneurysms after previous endovascular treatment. The mean age of the patients was 49 years (range of 27–85 years). The mean interval between coiling and clipping was 79 weeks (range of 0–288 weeks). Indications for surgical treatment were incomplete coiling, regrowth of a residual neck, or compaction of coils. All aneurysms were located at the anterior circulation.
Results: Ten patients revealed a regrowth of coiled aneurysms, while in 4 patients compaction of coils was present as a mechanism for aneurysma reperfusion. Nine patients showed a residual perfusion of the aneurysm initially after endovascular coiling. Coil extrusion was observed in 8 patients intraoperatively. In case of coil obstruction at the aneurysmal neck during surgery, coils were partially or completely removed to allow safe positioning of the clip. In all cases complete occlusion of the aneurysms was surgically achieved as proven by postoperative angiography. One patient with initial Hunt and Hess grade IV died because of severe vasospasm. There was no additional surgical morbidity in other patients.
Conclusions: Coiled aneuryms with incomplete occlusion, coil compaction or regrowth of the aneurysmal neck can be successfully treated with microsurgical clipping. Coil extrusion was more often observed intraoperatively than expected. Complete occlusion of the aneurysm can be performed, even if loops of coils protrude into the aneurysmal neck. In these cases intraoperative removal of the coils enables secure closure of the aneurysm with a surgical clip. Follow-up angiography after endovascular coiling of aneurysms should be considered mandatory.
