Neurosurgical treatment for aneurysm remnants or recurrences after coil occlusion

Neurosurgery. 2008 Oct;63(4):684-91; discussion 691-2. doi: 10.1227/01.NEU.0000325499.82876.6D.

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.

MeSH terms

  • Adult
  • Aged
  • Cerebral Angiography
  • Embolization, Therapeutic* / adverse effects
  • Female
  • Glasgow Outcome Scale
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Neurosurgical Procedures* / adverse effects
  • Prostheses and Implants
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Surgical Instruments
  • Treatment Outcome
  • Vascular Surgical Procedures* / adverse effects