Abstract
Background and aims: Recent advances in neurosurgery and interventional neuroradiology have brought us a new aspect in the treatment of cerebral aneurysms. The present single-surgeon series provides a balanced overview of the treatment of ruptured aneurysms in surgical clipping and coil embolization.
Clinical materials and methods: One hundred consecutive patients with ruptured cerebral aneurysms underwent surgical clipping or endovascular coil embolization between January 2005 and December 2007. All patients underwent clipping or coil embolization of at least one ruptured cerebral aneurysm by a single neurosurgeon (YK) who performed both the surgical clipping and endovascular coiling.
Results: Of the 48 surgically treated patients, 37 (77.1%) achieved a favorable outcome. Of the 52 patients who underwent endovascular embolization, 37 (71.2%) achieved a favorable outcome. No significant difference was observed regarding the proportion of favorable outcomes between the two treatment modalities. Five patients (9.6%) who underwent endovascular embolization needed re-treatments, while no re-treatment was necessary in the surgically treated patients. The rates of symptomatic vasospasm and shunt dependent hydrocephalus were 18.8% and 14.6%, respectively, in the clipped patients, and 19.2% and 21.2%, respectively, in the coiled patients. Endovascular coiling of ruptured aneurysms has a tendency towards a higher risk of developing shunt dependent hydrocephalus.
Conclusion: A combined microsurgical-endovascular approach can achieve the best outcomes for patients with ruptured cerebral aneurysms. Our findings support the policy of “Clip and Coil, not Clip versus Coil.”
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References
Guglielmi G, Viñuela F, Dion J, Duckwiler GR (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75:8–14
International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274
Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold J, Sandercock P, for the International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2005) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366: 809–817
Britz GW (2005) ISAT trial: coiling or clipping for intracranial aneurysms? Lancet 366:783–785
Derdeyn C, Barr JD, Berenstein A, Connors JJ, Dion JE, Duckwiler GR, Higashida RT, Strother CM, Tomsick TA, Turski P (2003) The international subarachnoid aneurysm trial (ISAT): a position statement from the executive committee of the American society of interventional and therapeutic neuroradiology and the American society of neuroradiology. Am J Neuroradiol 24:1404–1408
Lanzino G, Fraser K, Kanaan Y, Kanaan Y, Wagenbach A (2006) Treatment of ruptured intracranial aneurysms since the international subarachnoid aneurysm trial: practice utilizing clip ligation and coil embolization as individual or complementary therapies. J Neurosurg 104:344–349
Kaku Y, Yoshimura S, Hayashi K, Ueda T, Sakai N (1999) Follow up study on intra-aneurysmal embolization for unruptured cerebral aneurysms. Intervent Neuroradiol 5(Suppl 1):89–92
Kaku Y, Hayashi K, Sawada M, Sakai N (2001) Long term angiographical follow up of cerebral aneurysms after coil embolization. Intervent Neuroradiol 7(Suppl 1):149–154
Kaku Y, Yoshimura S, Kokuzawa J, Sakai N (2003) Clinical and angiographic results of intra-aneurysmal embolization for cerebral aneurysms and histopathological findings in an aneurysm treated with GDC. Intervent Neuroradiol 9(Suppl 1):35–40
Mericle RA, Wakhloo AK, Lopes DK, Lanzino G, Guterman LR, Hopkins LN (1998) Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. J Neurosurg 89:142–145
Sluzewski M, Rooij WJV, Beute GN, Nijssen PC (2005) Late rebleeding of ruptured intracranial aneurysms treated with detachable coils. Am J Neuroradiology 26:2542–2549
Kaku Y (2002) Endovascular aneurysm treatment from the neurosurgeon’s point of view. Acta Neurochir (Suppl) 82:99–103
Kaku Y (2005) Comparative view between the conventional microsurgical method and endovascular method for the treatment of cerebral aneurysms. Acta Neurochirurgica (Suppl) 94:11–15
Kaku Y, Watarai H, Kokuzawa J, Tanaka T, Andoh T (2007) Cerebral aneurysms: Conventional microsurgical technique and endovascular method. Surg Technol Int 16:228–235
Kaku Y, Watarai H, Kokuzawa J, Tanaka T, Andoh T (2007) Treatment of cerebral aneurysms -surgical clipping and coil embolization-. Intervent Neuroradiol 13(Suppl 1):68–72
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Kaku, Y., Yamashita, K., Kokuzawa, J., Hatsuda, N., Andoh, T. (2010). Treatment of Ruptured Cerebral Aneurysms – Clip and Coil, Not Clip Versus Coil. In: Surgical Management of Cerebrovascular Disease. Acta Neurochirurgica Supplementum, vol 107. Springer, Vienna. https://doi.org/10.1007/978-3-211-99373-6_2
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DOI: https://doi.org/10.1007/978-3-211-99373-6_2
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