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Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization – a quest for the ultimate therapy

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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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Authors and Affiliations

  1. Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan

    Ariyan Pirayesh, Nakao Ota, Kosumo Noda, Ioannis Petrakakis, Hiroyasu Kamiyama, Sadahisa Tokuda & Rokuya Tanikawa

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  1. Ariyan Pirayesh
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  2. Nakao Ota
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  3. Kosumo Noda
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  4. Ioannis Petrakakis
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  5. Hiroyasu Kamiyama
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Contributions

The contribution of the authors to this study can be itemised as follows:

Conceptualization – Ariyan Pirayesh, Ioannis Petrakakis, Rokuya Tanikawa; Data curation – Ariyan Pirayesh, Nakao Ota; Formal Analysis – Ariyan Pirayesh, Rokuya Tanikawa; Investigation – Ariyan Pirayesh, Rokuya Tanikawa; Methodology – Ariyan Pirayesh, Rokuya Tanikawa, Hiroyasu Kamiyama; Project administration – Rokuya Tanikawa, Hiroyasu Kamiyama, Sadahisa Tokuda; Resources – Nakao Ota; Supervision – Rokuya Tanikawa; Validation – Rokuya Tanikawa; Visualization – Kosumo Noda, Ariyan Pirayesh; Writing (original draft) – Ariyan Pirayesh; Writing (review & editing) – Ariyan Pirayesh, Rokuya Tanikawa.

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Correspondence to Ariyan Pirayesh.

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Pirayesh, A., Ota, N., Noda, K. et al. Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization – a quest for the ultimate therapy. Neurosurg Rev 44, 1031–1051 (2021). https://doi.org/10.1007/s10143-020-01290-7

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