Early and late microsurgical clipping for initially coiled intracranial aneurysms.

INTRODUCTION

An increasing number of patients with incompletely treated and recurrent intracranial aneurysms are presenting for further management. We review the patients who underwent microsurgical clipping of previously coiled intracranial aneurysms.

METHODS

From 2001 to 2008, we treated 623 aneurysms by endovascular treatment. Among them, 29 patients underwent microsurgical clipping. Nineteen patients (group A) underwent early surgical intervention due to incomplete coiling, a residual neck, coil protrusion, aneurysm rupture, or coil stretching. Ten patients (group B) underwent surgical clipping for recurrent aneurysm and an increased mass effect during the follow-up period. The radiographic images and clinical data were reviewed retrospectively to determine the treatment efficacy, the clinical outcomes, and the factors that are important to select the proper treatment modality.

RESULTS

There were 13 female and 16 male patients. The coils were removed in 6 of the 19 patients in group A and in 1 of the 10 patients in group B. Seventeen (89.5%) of the 19 patients in group A and all the patients (100%) in group B achieved good recovery (Glasgow Outcome Scale 5 and 4) during the clinical follow-up periods (mean 25.2 months).

CONCLUSION

Microsurgical clipping may be chosen as a safe and permanent treatment option for the previously coiled aneurysms with acceptable morbidity in properly selected cases.