Article
Clipping of previously coiled cerebral aneurysms
Clipping von zuvor gecoilten zerebralen Aneurysmen
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Authors
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Josef M. Lang
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Friedrich Götz
- Medizinische Hochschule Hannover, Institut für Diagnostische und Interventionelle Neuroradiologie, Hannover, Deutschland
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Makoto Nakamura
- Kliniken der Stadt Köln, Klinik für Neurochirurgie, Köln, Deutschland
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Joachim K. Krauss
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Recurrent, residual and regrowing cerebral aneurysms after coil embolization remain a challenging task. Depending on angiographic findings, treatment options include microsurgical clipping, re-coil embolization, flow diverter implantation or observation.
Methods: From 2006 to 2019, a total of 23 patients with residual, regrowing or recurrent previously coil embolized cerebral aneurysms were treated with microsurgical clipping. The mean age of the patients was 53 years (range 27-85 years) and the mean interval between coil embolization and microsurgical clipping was 105 weeks (range 0-547 weeks).
Results: 20 patients (87%) initially had a subarachnoid hemorrhage from ruptured cerebral aneurysm. Three patients had an incidental aneurysm. Aneurysm location was anterior communicating artery in 9 patients (39%), middle cerebral artery in 5 patients (22%), posterior communicating artery in 4 patients (17%), and carotid internal artery in 3 patients. Fourteen patients showed regrowth of formerly coiled aneurysms, in five patients coil compaction was present, and four patients revealed a residual neck. Coil extrusion was observed intraoperatively in 9 patients (39%). Complete coil removal was performed in 6 patients, partial coil removal was necessary in 4 patients. In all 23 patients, a complete aneurysm occlusion was achieved successfully by microsurgical clipping. 22 patients (96%) showed no surgery-related complications, one patient had a hemiparesis postoperatively. One patient with subarachnoid hemorrhage developed severe cerebral vasospasm with consecutive fatal outcome.
Conclusion: Microsurgical clipping of previously coiled cerebral aneurysms with recurrent filling, residual neck or regrowth is a save, effective and sustainable treatment option in selected patients when performed in experienced hands.
