Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures

Endovascular treatment of ruptured anterior communicating artery aneurysms. Results and technical considerations

SUMMARY

The aim of this paper is to provide a review of our experience in using the endovascular treatment of ruptured anterior communicating artery (ACoA) aneurysms. Between March 1997 and May 2004, 211 ruptured aneurysms were treated with Guglielmi detachable coil (GDC) system in Mito Medical Center, 73 were located at the ACoA.Two cases were incomplete embolization, and performed microsurgical clipping. In the initial embolization for the 71 aneurysms, complete occlusion was achieved in 44 aneurysms, neck remnant in 11 aneurysms and body filling in 16 aneurysms. Intra-operative complication was occurred in six cases (8.2%). Aneurysm perforation was occurred in three cases (4.1%), thromboembolic complication was occurred in three cases (4.1%). Acute rebleeding were observed in two cases (2.7%). Endovascular treatment is an effective technique for treating ACoA aneurysms, and 3D-rotational angiography is important diagnostic tool for evaluating the ACoA complex.

Distractable vertebral cages for reconstruction after cervical corpectomy

STUDY DESIGN

Retrospective study of 20 patients with degenerative cervical spinal canal stenosis who were treated with corpectomy followed by the placement of a distractable titanium cage (anterior distraction device [ADD]) (Ulrich GmbH & Co. KG, Ulm, Germany).

OBJECTIVE

To investigate the efficacy of distractable titanium cages for reconstruction following decompressive cervical corpectomy.

SUMMARY OF BACKGROUND DATA

Anterior corpectomy and reconstruction for extensive spinal canal stenosis are standard techniques. The reconstruction is commonly performed with bone graft and anterior plating. Alternatively, different fusion cages have gained acceptance in spine surgery. However, in traditionally designed cages, an over-distraction of the involved segment is necessary to place the cage into the defect, and to achieve tight contact between cage and endplates. The new designed cage (ADD) can be distracted in situ. Therefore, the height of the cage can be adjusted precisely to the size of the corpectomy.

METHODS

All patients were treated with corpectomy followed by the placement of an ADD. A cervical plate was added in 13 cases, and an "All-in-one-system" (i.e., a cage with an attached plate with 2 holes for screw fixation on both sides, ADD) was used in 7. Follow-up was 18-60 months. Clinical evaluation and radiographs were performed after 3, 6, and 12 months, and then once a year.

RESULTS

In all cases, a stable reconstruction of the anterior column was achieved, with no signs of instability on flexion/extension radiographs. However, there was one incidence of cage subsidence. According to Odom criteria, 11 patients (55%) had excellent outcome, 4 (20%) good, 3 (15%) satisfactory, and 2 (10%) poor.

CONCLUSIONS

The results of the study show that distractable cages are useful vertebral body replacements because they can be adjust to the size of the corpectomy in situ and provide immediate strong anterior column support, avoiding bone graft site morbidity. The possibility of direct cage fixation without an additional plate simplifies the procedure.

Current treatment options for unruptured intracranial aneurysms

A patient with an unruptured intracranial aneurysm has three options: surgical clip placement, endovascular coil occlusion, and observation. The decision making about management of these lesions should be based on the risk of aneurysm rupture and the risks associated with surgical or endovascular intervention. For patients who require interventions, factors such as aneurysm recurrence rate, its location, surgical or endovascular accessibility, the patient's general medical condition, and the individual's treatment preference should be taken into account to determine the choice of therapies. Currently, a team approach by neurosurgeons and endovascular interventionists is recommended to evaluate each patient and to tailor the best treatment plan.