Skip Navigation LinksHome > October 2008 - Volume 63 - Issue 4 > NEUROSURGICAL TREATMENT FOR ANEURYSM REMNANTS OR RECURRENCES...
Neurosurgery:
doi: 10.1227/01.NEU.0000325499.82876.6D
Clinical Studies

NEUROSURGICAL TREATMENT FOR ANEURYSM REMNANTS OR RECURRENCES AFTER COIL OCCLUSION

Lejeune, Jean-Paul M.D.; Thines, Laurent M.D.; Taschner, Christian M.D.; Bourgeois, Philippe M.D.; Henon, Hilde M.D.; Leclerc, Xavier M.D., Ph.D.

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Abstract

OBJECTIVE: Neurosurgical management of residual aneurysms (RA) after coiling remains a challenging issue. We present a consecutive series of 21 patients who underwent microsurgical treatment of a previously coiled aneurysm.

METHODS: We retrospectively reviewed a consecutive series of 21 patients who underwent operations for an RA after coiling between 1997 and 2007. Postcoiling follow-up imaging included brain magnetic resonance angiography and digital subtraction angiography. The decision for surgical treatment was made when an RA was significant and unsuitable for re-embolization. Data related to the RA and to the surgical technique were analyzed. Postoperative outcome was evaluated with the Glasgow Outcome Scale.

RESULTS: Twenty aneurysms were initially ruptured. Twelve had undergone complete coil occlusion, whereas 6 had a residual neck, 2 had a residual lobule, and 1 had a residual sac. The aneurysms were in the anterior circulation in 18 cases and in the posterior circulation in 3 cases. Twenty RAs were excluded with the apposition of 1 clip beneath the coils, 2 required a temporary occlusion, 2 required extraction of the coils, and 1 presented with an operative rupture. All aneurysms, except 2 that had their residual neck wrapped, were completely occluded. The postoperative Glasgow Outcome Scale score was unchanged in 90% of patients, and 2 patients sustained a moderate disability.

CONCLUSION: Microsurgical treatment of RA after endovascular treatment is effective, provided that patients are selected appropriately. The surgical treatment of recanalized aneurysms after coiling is challenging but can result in a good outcome with low morbidity and no mortality.

Copyright © by the Congress of Neurological Surgeons

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