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Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization - a quest for the ultimate therapy.
- Source :
-
Neurosurgical review [Neurosurg Rev] 2021 Apr; Vol. 44 (2), pp. 1031-1051. Date of Electronic Publication: 2020 Mar 24. - Publication Year :
- 2021
-
Abstract
- The long-term stability of coil embolization (CE) of complex intracranial aneurysms (CIAs) is fraught with high rates of recanalization. Surgery of precoiled CIAs, however, deviates from a common straightforward procedure, demanding sophisticated strategies. To shed light on the scope and limitations of microsurgical re-treatment, we present our experiences with precoiled CIAs. We retrospectively analysed a consecutive series of 12 patients with precoiled CIAs treated microsurgically over a 5-year period, and provide a critical juxtaposition with the literature. Five aneurysms were located in the posterior circulation, 8 were large-giant sized, 5 were calcified/thrombosed. One presented as a dissecting-fusiform aneurysm, 9 ranked among wide neck aneurysms. Eight lesions were excluded by neck clipping (5 necessitating coil extraction); 1 requiring adjunct CE. The dissecting-fusiform aneurysm was resected with reconstruction of the parent artery using a radial artery graft. Three lesions were treated with flow alteration (parent artery occlusion under bypass protection). Mean interval coiling-surgery was 4.6 years (range 0.5-12 years). Overall, 10 aneurysms were successfully excluded; 2 lesions treated with flow alteration displayed partial thrombosis, progressing over time. Outcome was good in 8 and poor in 4 patients (2 experiencing delayed neurological morbidity), and mean follow-up was 24.3 months. No mortality was encountered. Microsurgery as a last resort for precoiled CIAs can provide-in a majority of cases-a definitive therapy with good outcome. Since repeat coiling increases the complexity of later surgical treatment, we recommend for this subgroup of aneurysms a critical evaluation of CE as an option for re-treatment.
- Subjects :
- Adult
Aged
Aged, 80 and over
Aortic Dissection diagnostic imaging
Embolization, Therapeutic trends
Endovascular Procedures methods
Endovascular Procedures trends
Female
Humans
Intracranial Aneurysm diagnostic imaging
Male
Microsurgery trends
Middle Aged
Neurosurgical Procedures methods
Neurosurgical Procedures trends
Recurrence
Reoperation trends
Retrospective Studies
Treatment Outcome
Aortic Dissection surgery
Blood Vessel Prosthesis trends
Embolization, Therapeutic methods
Intracranial Aneurysm surgery
Microsurgery methods
Reoperation methods
Subjects
Details
- Language :
- English
- ISSN :
- 1437-2320
- Volume :
- 44
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Neurosurgical review
- Publication Type :
- Academic Journal
- Accession number :
- 32212048
- Full Text :
- https://doi.org/10.1007/s10143-020-01290-7