1Department of Neurosurgery, Sestre milosrdnice University Hospital Canter, Zagreb, Croatia; 2University of Applied Health Sciences, Zagreb, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
Acta Clin Croat. 2021 Dec;60(4):695-702. doi: 10.20471/acc.2021.60.04.17.
Microsurgical clipping and endovascular coiling are both effective management modalities for intracranial aneurysms, whereas recent procedures are mainly directed towards endovascular treatment because of its minimally invasive nature. However, such a treatment has been associated with a bigger risk of recurrent aneurysmal growth and re-bleeding urging a selection of optimal strategies to overcome these hazards. It seems that the most appropriate method of choice is microsurgical clipping, which is much more technically challenging due to recurrent aneurysm demanding configuration created by the initial coiling. Herein, we present an illustrative institutional case series of recurrent intracranial aneurysms following endovascular treatment, and discuss the controversies and benefits of their subsequent microsurgical management, based on our experience and on literature review. Considering the results reported in this paper, it seems that careful selective microsurgical neck clipping with/without aneurysmal sac resection and coil extraction remains the preferred management option for recurrent intracranial aneurysms, resulting in high obliteration rates, long-term occlusion stability, and low morbidity/mortality. In conclusion, to bring a satisfactory outcome, the multidisciplinary management of recurrent intracranial aneurysms after endovascular treatment should be adjusted to aneurysm morphology/size/location, and individualized according to patient needs.
显微夹闭和血管内栓塞都是颅内动脉瘤的有效治疗方法，而由于其微创性，最近的治疗方法主要针对血管内治疗。然而，这种治疗与更大的复发性动脉瘤生长和再出血风险相关，需要选择最佳策略来克服这些风险。似乎最合适的选择方法是显微夹闭，由于初始栓塞所形成的反复出现的动脉瘤，该方法在技术上更具挑战性。在此，我们根据我们的经验和文献复习，介绍了一系列在血管内治疗后复发性颅内动脉瘤的有代表性的机构病例，并讨论了随后的显微手术治疗的争议和益处。考虑到本文报道的结果，似乎对于复发性颅内动脉瘤，仔细选择的显微颈夹闭术（有/无动脉瘤囊切除术和线圈取出术）仍然是首选的治疗方法，其具有较高的闭塞率、长期闭塞稳定性和较低的发病率/死亡率。总之，为了达到满意的结果，血管内治疗后复发性颅内动脉瘤的多学科管理应根据动脉瘤的形态/大小/位置进行调整，并根据患者的需求进行个体化治疗。
