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Inci S, Karakaya D. Microsurgical Treatment of Previously Coiled Giant Aneurysms: Experience with 6 Cases and Literature Review. World Neurosurg 2023; 171:e336-e348. [PMID: 36513298 DOI: 10.1016/j.wneu.2022.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Surgical treatment of insufficiently embolized (coiled) or recurrent giant aneurysms has not been well established in the literature. The aim of this study is to bring up the surgical difficulties of these rare aneurysms and to offer solutions. METHODS A database was queried for giant aneurysms that had been previously embolized and subsequently required surgical treatment. We only found 29 aneurysms in the literature and here, we report 6 more surgical cases with patient characteristics, radiological studies, applied surgical techniques, and outcomes which were reviewed retrospectively. RESULTS Four females and 2 males, with a mean age of 45.6 years took part in the study. The most common aneurysm location was the middle cerebral artery. While 5 aneurysms were successfully clipped, 1 was excised and the neck was closed with micro sutures. The coils were compulsorily removed in 3 patients. Postoperative digital subtraction angiography confirmed total occlusion of the aneurysms in all cases. Overall morbidity was 16.6%. There was no mortality. No recurrence was observed in the angiographic follow-up (mean 22.6 months, range 7-47 months). The literature review also determined that 97.1% of 35 previously coiled giant aneurysms (including ours) were occluded using various surgical techniques, with 82.8% good outcome. CONCLUSIONS Surgical clipping is a safe and effective procedure for the treatment of insufficiently embolized or recurrent giant aneurysms after coiling. If possible, the coils should not be removed. However, if safe clipping is not possible due to the coils, the removal of the coils should not be avoided.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
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Pirayesh A, Ota N, Noda K, Petrakakis I, Kamiyama H, Tokuda S, Tanikawa R. Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization - a quest for the ultimate therapy. Neurosurg Rev 2020; 44:1031-1051. [PMID: 32212048 DOI: 10.1007/s10143-020-01290-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Ariyan Pirayesh
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan.
| | - Nakao Ota
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Kosumo Noda
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Ioannis Petrakakis
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
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Costa E, Vaz G, Finet P, Goffette P, Docquier MA, Raftopoulos C. Recanalization and rupture after intracranial aneurysm treatment. J Neurosurg Sci 2019; 63:518-524. [DOI: 10.23736/s0390-5616.16.03882-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clipping of Recurrent Cerebral Aneurysms After Coil Embolization. ACTA NEUROCHIRURGICA. SUPPLEMENT 2018; 129:53-59. [PMID: 30171314 DOI: 10.1007/978-3-319-73739-3_8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS To assess the technical points of surgical clipping for recurrent aneurysms after coiling, we examine a consecutive series of 14 patients who underwent re-treatment. MATERIALS AND METHODS From 2009 to 2016, 27 recurrent aneurysms after coiling were re-treated with endovascular treatment or surgical clipping. Of these, 14 were re-treated surgically. In cases where the remnant neck was sufficiently large, neck clipping was chosen. Where the remnant neck was too small and the border between the thrombosed and non-thrombosed portion was distinct, partial clipping was chosen. Surgical clipping was attempted without removing the coils when technically feasible. RESULTS Among the 14 cases, neck clipping was performed in 11, partial clipping in 2, and trapping with bypass in 1 case. Clipping without removal of coils was accomplished in all cases. No neurological deterioration occurred after surgical clipping in any case. CONCLUSION Clipping of recurrent aneurysms after coiling can compensate for the failure of initial endovascular therapy. For clipping without removal of coils, precise evaluation of the remnant neck is required. Bypass surgery is key to treatment in the case of aneurysm trapping.
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Toyota S, Taki T, Wakayama A, Yoshimine T. Retreatment of Recurrent Internal Carotid-Posterior Communicating Artery Aneurysm after Coil Embolization. Neurol Med Chir (Tokyo) 2015; 55:838-47. [PMID: 26437796 PMCID: PMC4663022 DOI: 10.2176/nmc.oa.2015-0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Internal carotid-posterior communicating artery (IC-PC) aneurysms account for more than 20% of all intracranial aneurysms. As a result of the increase in coiling, there has also been an increase in recurrent IC-PC aneurysms after coiling. We present our experience of 10 recurrent IC-PC aneurysms after coiling that were retreated using surgical or endovascular techniques in order to discuss the choice of treatment and the points of clipping without removal of coils. From 2007 to 2014, 10 recurrent IC-PC aneurysms after coiling were retreated. When the previous frames covered the aneurysms all around or almost around except a part of the neck, coiling was chosen. In other cases, clipping was chosen. Clipping was attempted without removal of coils when it was technically feasible. Among the 10 IC-PC aneurysms retreated, 3 were retreated with coiling and 7 were retreated with clipping. In all three cases retreated with coiling, almost complete occlusion was accomplished. In the seven cases retreated with clipping, coil extrusion was observed during surgery in six cases. In most of them, it was necessary to dissect strong adhesions around the coiled aneurysms and to utilize temporary occlusion of the internal carotid artery. In all seven cases, neck clipping was accomplished without the removal of coils. There were no neurological complications in any cases. The management of recurrent lesions of embolized IC-PC aneurysms requires appropriate choice of treatment using both coiling and clipping. Clipping, especially without the removal of coils, plays an important role in safe treatment.
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Arnaout OM, El Ahmadieh TY, Zammar SG, El Tecle NE, Hamade YJ, Aoun RJN, Aoun SG, Rahme RJ, Eddleman CS, Barrow DL, Batjer HH, Bendok BR. Microsurgical Treatment of Previously Coiled Intracranial Aneurysms: Systematic Review of the Literature. World Neurosurg 2015; 84:246-53. [PMID: 25731797 DOI: 10.1016/j.wneu.2015.02.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess indications, complications, clinical outcomes, and technical nuances of microsurgical treatment of previously coiled intracranial aneurysms. METHODS A systematic review of the literature was performed using PubMed/MEDLINE and EMBASE databases from January 1990 to December 2013. English-language articles reporting on microsurgical treatment of previously coiled intracranial aneurysms were included. Articles that involved embolization materials other than coils were excluded. Data on aneurysm characteristics, indications for surgery, techniques, complications, angiographic obliteration rates, and clinical outcomes were collected. RESULTS The literature review identified 29 articles reporting on microsurgical clipping of 375 previously coiled aneurysms. Of the aneurysms, 68% were small (<10 mm). Indications for clipping included the presence of a neck remnant (48%) and new aneurysmal growth (45%). Rebleeding before clipping was reported in 6% of cases. Coil extraction was performed in 13% of cases. The median time from initial coiling to clipping was 7 months. The angiographic cure rate was 93%, with morbidity and mortality of 9.8% and 3.6%, respectively. CONCLUSIONS Microsurgical clipping of previously coiled aneurysms can result in high obliteration rates with relatively low morbidity and mortality in select cases. Considerations for microsurgical strategies include the presence of sufficient aneurysmal tissue for clip placement and the potential need for temporary occlusion or flow arrest. Coil extraction is not needed in most cases.
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Affiliation(s)
- Omar M Arnaout
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samer G Zammar
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Youssef J Hamade
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Rami James N Aoun
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Christopher S Eddleman
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel L Barrow
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - H Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
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