Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks

Ann Neurol. 2000 Jul;48(1):11-9. doi: 10.1002/1531-8249(200007)48:1<11::aid-ana4>3.3.co;2-m.


Unruptured cerebral aneurysms are commonly treated by surgical clipping, but endovascular coil embolization is increasingly employed as an alternative. In a blinded review of unruptured aneurysms treated at our institution since 1990, we identified patients whose aneurysms were judged to be treatable by both neurosurgeons and neurointerventional radiologists. A change in Rankin Scale score of 2 or more from hospital admission to discharge, indicating a new moderate disability or worse, was predefined as the primary outcome measure. Long-term follow-up was obtained by mailed questionnaire and telephone interview. Length of stay and hospital charges were totaled for all hospitalizations, including follow-up. Sixty-eight patients treated surgically and 62 patients treated with endovascular coil embolization were considered candidates for either procedure on blinded review, and overall anticipated procedure risk was rated as identical. A larger proportion of patients in the surgical group developed a change in Rankin Scale score of 2 or more (25% of surgical patients vs 8% of endovascular patients). Total length of stay was longer (mean days: 7.7 for surgical patients vs 5.0 for endovascular patients) and hospital charges were greater (mean, $38,000 for surgical patients vs $33,400 for endovascular patients) for the surgical patients. At follow-up, an average of 3.9 years after the procedure, surgical patients were more likely to report persistent new symptoms or disability since treatment (34% of surgical patients vs 8% of endovascular patients) and a longer period for recovery to normal (50% returning to normal in 1 year for surgery and in 27 days for coil embolization). Coil embolization of unruptured cerebral aneurysms seems to be associated with significantly fewer complications than surgical clipping. More long-term data on aneurysm rupture rates are required to confirm efficacy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cerebral Arteries / surgery
  • Embolization, Therapeutic / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / surgery*
  • Intraoperative Complications / etiology
  • Intraoperative Complications / mortality
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Rupture, Spontaneous / surgery
  • Surgical Instruments