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Paradigms for single-patient multimodality treatment for cerebral aneurysms: single-center eleven-year experience

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Abstract

Endovascular and surgical techniques are conventional options for treating intracranial aneurysms, but criteria for selecting an optimal approach for individual patients remain variable across practitioners and institutions. While endovascular and surgical approaches are generally used alone, both modalities combined in single patients can produce efficacious outcomes. The aim of this study was to evaluate outcomes of combined, concomitant endovascular and surgical modalities in the treatment of multiple and/or complex aneurysms in single patients. Indications, sequencing rationale, and categorization for multimodality treatments are reviewed. All intracranial aneurysms treated at our institution from 2004 to 2014 were reviewed. Single patients who had undergone concomitant endovascular and surgical treatments were eligible for participation in our study. Demographic data and clinical presentation parameters, including location, size, and morphological features of lesions, treatment sequencing, and outcomes were recorded. Our cohort consisted of 27 patients with 57 aneurysms who received concomitant endovascular and surgical treatment of their aneurysm(s). One patient arrived to us after he had an aneurysm clipped at an outside institution and then required treatment for a contralateral ruptured aneurysm. 66.7% of patients were diagnosed with subarachnoid hemorrhage. These were subdivided according to therapeutic approach: clipping and coiling (CL+CO), clipping and stenting (CL+ST), bypass and endovascular parent vessel occlusion (PVO) (BY+PVO), attempted clipping then stenting, and bypass followed by stenting. Glasgow Outcome Scale was as follows: CL-CO-Multiple, 4.17 (five in unruptured patients, 3.75 in ruptured); CO-CL-Multiple, five (all patients had a ruptured aneurysm); CL-CO-Single, three (all patients had a ruptured aneurysm); CO-CL-Single, five (all patients had a ruptured aneurysm). No patients suffered a new neurological deficit as a result of treatment. A total of two mortalities were documented. Concomitant, mutimodality endovascular and surgical therapy may offer a safe and potentially more effective paradigm than single modality approaches for the management of multiple, complex, or “failed” aneurysm treatments in selected patients.

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Authors and Affiliations

  1. Department of Neurosurgery, Hofstra Northwell School of Medicine, and Northwell Health, 300 Community Drive, 9 Tower, Manhasset, NY, USA

    Abdullah Alobaid, Katherine Wagner, Avi Setton, Amir R. Dehdashti & David Chalif

  2. Division of Neurosurgery, Maimonides Medical Center, Brooklyn, NY, USA

    Erez Nossek

  3. Department of Neurosurgery, Hofstra Northwell School of Medicine, and Northwell Health, Lenox-Hill Hospital, NY, USA

    David Langer

Authors
  1. Abdullah Alobaid
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  2. Erez Nossek
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  3. Katherine Wagner
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  4. Avi Setton
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  5. Amir R. Dehdashti
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  6. David Langer
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  7. David Chalif
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Correspondence to David Chalif.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Alobaid, A., Nossek, E., Wagner, K. et al. Paradigms for single-patient multimodality treatment for cerebral aneurysms: single-center eleven-year experience. Neurosurg Rev 40, 495–506 (2017). https://doi.org/10.1007/s10143-016-0810-z

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  • DOI: https://doi.org/10.1007/s10143-016-0810-z

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