Surgical treatment for cerebral aneurysm after incomplete Guglielmi detachable coil embolization
Kuroda, S.; Ushikoshi, S.; Niiya, Y.; Osanai, T.; Ishikawa, T.; Takikawa, S.; Houkin, K.; Iwasaki, Y.
No Shinkei Geka. Neurological Surgery 32(6): 645-650
2004
ISSN/ISBN: 0301-2603 PMID: 15352635 Document Number: 571764
The frequency of surgical treatment for intracranial aneurysms that have been incompletely treated by endovascular coiling will increase in time. The authors describe their experience in the following 3 patients. There was one non-ruptured aneurysm and two ruptured ones. The intervals between coiling and surgery were 1, 5, and 10 months. Surgery was indicated because of partial treatment and/or growth of residual neck. Observation during surgery revealed that coils were exposed to the subarachnoid space at the tip of the aneurysm in the cases of ruptured aneurysms. When the residual neck was large enough for the size of the clip blades, there was no need to remove the coils. The coils in the neck were able to be removed when the interval between coiling and surgery was very short, but could not be removed when the interval was prolonged. Intraoperative angiography and reconstructive bypass surgery may be essential in these complex cases. As pointed out previously, the operative approach should be determined by the need for coil removal and the duration since coiling.