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Inci S, Karakaya D. Microsurgical Treatment of Previously Coiled Giant Aneurysms: Experience with 6 Cases and Literature Review. World Neurosurg 2023; 171:e336-e348. [PMID: 36513298 DOI: 10.1016/j.wneu.2022.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Surgical treatment of insufficiently embolized (coiled) or recurrent giant aneurysms has not been well established in the literature. The aim of this study is to bring up the surgical difficulties of these rare aneurysms and to offer solutions. METHODS A database was queried for giant aneurysms that had been previously embolized and subsequently required surgical treatment. We only found 29 aneurysms in the literature and here, we report 6 more surgical cases with patient characteristics, radiological studies, applied surgical techniques, and outcomes which were reviewed retrospectively. RESULTS Four females and 2 males, with a mean age of 45.6 years took part in the study. The most common aneurysm location was the middle cerebral artery. While 5 aneurysms were successfully clipped, 1 was excised and the neck was closed with micro sutures. The coils were compulsorily removed in 3 patients. Postoperative digital subtraction angiography confirmed total occlusion of the aneurysms in all cases. Overall morbidity was 16.6%. There was no mortality. No recurrence was observed in the angiographic follow-up (mean 22.6 months, range 7-47 months). The literature review also determined that 97.1% of 35 previously coiled giant aneurysms (including ours) were occluded using various surgical techniques, with 82.8% good outcome. CONCLUSIONS Surgical clipping is a safe and effective procedure for the treatment of insufficiently embolized or recurrent giant aneurysms after coiling. If possible, the coils should not be removed. However, if safe clipping is not possible due to the coils, the removal of the coils should not be avoided.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
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2
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Zheng Y, Zheng L, Sun Y, Lin D, Wang B, Sun Q, Bian L. Surgical Clipping of Previously Coiled Recurrent Intracranial Aneurysms: A Single-Center Experience. Front Neurol 2021; 12:680375. [PMID: 34621232 PMCID: PMC8490643 DOI: 10.3389/fneur.2021.680375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: This study reviews our experiences in surgical clipping of previously coiled aneurysms, emphasizing on recurrence mechanism of intracranial aneurysms (IAs) and surgical techniques for different types of recurrent IAs. Method: We performed a retrospective study on 12 patients who underwent surgical clipping of aneurysms following endovascular treatment between January 2010 and October 2020. The indications for surgery, surgical techniques, and clinical outcomes were analyzed. Result: Twelve patients with previously coiled IAs were treated with clipping in this study, including nine females and three males. The reasons for the patients having clipping were as follows: early surgery (treatment failure in two patients, postoperative early rebleeding in one patient, and intraprocedural aneurysm rupture during embolization in one patient) and late surgery (aneurysm recurrence in five patients, SAH in one, mass effect in one, and aneurysm regrowth in one). All aneurysms were clipped directly, and coil removal was performed in four patients. One patient died (surgical mortality, 8.3%), 1 patient (8.3%) experienced permanent neurological morbidity, and the remaining 10 patients (83.4%) had good outcomes. Based on our clinical data and previous studies, we classified the recurrence mechanism of IAs into coil compaction, regrowth, coil migration, and coil loosening. Then, we elaborated the specific surgical planning and timing of surgery depending on the recurrence type of IAs. Conclusion: Surgical clipping can be a safe and effective treatment strategy for the management of recurrent coiled IAs, with acceptable morbidity and mortality in properly selected cases. Our classification of recurrent coiled aneurysms into four types helps to assess the optimal surgical approach and the associated risks in managing them.
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Affiliation(s)
- Yongtao Zheng
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lili Zheng
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuhao Sun
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Lin
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Baofeng Wang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingfang Sun
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liuguan Bian
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Bao Q, Meng X, Hu M, Xing J, Jin D, Liu H, Jiang J, Yin Y. Simulation analysis of aneurysm embolization surgery: Hemorheology of aneurysms with different embolization rates (CTA). Biomed Mater Eng 2021; 32:295-308. [PMID: 33998529 DOI: 10.3233/bme-211225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Embolization degree acts as an important factor affecting recurrence of aneurysm. OBJECTIVE To analyze the role of hemodynamics parameters of different degrees of embolization in the occurrence, development and post-treatment of aneurysms, and to determine the specific factors causing the occurrence and recurrence of aneurysms after hemodynamics treatment. Our study provides a theoretical basis for the prevention and treatment of aneurysms. METHODS Computed tomography angiography data of a patient with cerebral aneurysm was used to model 0%, 24%, 52%, 84% and 100% of endovascular embolization, respectively. The time average wall shear stress, time average wall shear stress, oscillatory shear index, hemodynamics formation index and relative retentive time were used to analyze the changes of hemodynamics indexes in different embolic models. RESULTS With the increase of embolic rate, the values of time average wall shear stress, time average wall shear stress grade and aneurysm index formation gradually increased, and the values of relative retention time gradually decreased. Oscillatory shear index was higher in patients with incomplete embolization and decreased in patients with complete embolization. CONCLUSIONS As the degree of embolization increased, the blood flow tended to stabilize, reducing the risk of cerebral aneurysm rupture, and finding that the wall of the vessel junction was susceptible to injury.
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Affiliation(s)
- Quan Bao
- Department of Image, Hongqi Hospital Affiliated with Mudanjiang Medical University, Mudanjiang, China
| | - Xin Meng
- Department of Image, No. 3 Hospital Affiliated with Qiqihaer Medical University, Qiqihaer, China
| | - Mingcheng Hu
- Department of Image, Hongqi Hospital Affiliated with Mudanjiang Medical University, Mudanjiang, China
| | - Jian Xing
- Department of Image, Hongqi Hospital Affiliated with Mudanjiang Medical University, Mudanjiang, China
| | - Dan Jin
- Department of Image, No. 2 Hospital of Mudanjiang, Mudanjiang, China
| | - He Liu
- Department of Image, Hongqi Hospital Affiliated with Mudanjiang Medical University, Mudanjiang, China
| | - Jie Jiang
- Department of Infectious Disease, Mudanjiang Forestry Center Hospital, Mudanjiang, China
| | - Yanwei Yin
- Department of Image, Hongqi Hospital Affiliated with Mudanjiang Medical University, Mudanjiang, China
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Raper DMS, Rutledge C, Winkler EA, Abla AA. Definitive Treatment With Microsurgical Clipping After Recurrence and Rerupture of Coiled Anterior Cerebral Artery Aneurysms. Oper Neurosurg (Hagerstown) 2020; 19:393-402. [PMID: 32409831 DOI: 10.1093/ons/opaa103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The extent of obliteration of ruptured intracranial aneurysms treated with coil embolization has been correlated with the risk of rerupture. However, many practitioners consider that a small neck remnant is unlikely to result in significant risk after coiling. OBJECTIVE To report our recent experience with ruptured anterior cerebral artery aneurysms treated with endovascular coiling, which recurred or reruptured, requiring microsurgical clipping for subsequent treatment. METHODS Retrospective review of patients with intracranial aneurysms treated at our institution since August 2018. Patient and aneurysm characteristics, initial and subsequent treatment approaches, and outcomes were reviewed. RESULTS Six patients were included. Out of those 6 patients, 5 patients had anterior communicating artery aneurysms, and 1 patient had a pericallosal aneurysm. All initially presented with subarachnoid hemorrhage (SAH) and were treated with coiling. Recurrence occurred at a median of 7.5 mo. In 2 cases, retreatment was initially performed with repeat endovascular coiling, but further recurrence was observed. Rerupture from the residual or recurrent aneurysm occurred in 3 cases. In 2 cases, the aneurysm dome recurred; in 1 case, rerupture occurred from the neck. All 6 patients underwent treatment with microsurgical clipping. Follow-up catheter angiography demonstrated a complete occlusion of the aneurysm in all cases with the preservation of the parent vessel. CONCLUSION Anterior cerebral artery aneurysms may recur after endovascular treatment, and even small neck remnants present a risk of rerupture after an initial SAH. Complete treatment requires a complete exclusion of the aneurysm from the circulation. Even in cases that have been previously coiled, microsurgical clipping can represent a safe and effective treatment option.
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Affiliation(s)
- Daniel M S Raper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Caleb Rutledge
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Pirayesh A, Ota N, Noda K, Petrakakis I, Kamiyama H, Tokuda S, Tanikawa R. Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization - a quest for the ultimate therapy. Neurosurg Rev 2020; 44:1031-1051. [PMID: 32212048 DOI: 10.1007/s10143-020-01290-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
The long-term stability of coil embolization (CE) of complex intracranial aneurysms (CIAs) is fraught with high rates of recanalization. Surgery of precoiled CIAs, however, deviates from a common straightforward procedure, demanding sophisticated strategies. To shed light on the scope and limitations of microsurgical re-treatment, we present our experiences with precoiled CIAs. We retrospectively analysed a consecutive series of 12 patients with precoiled CIAs treated microsurgically over a 5-year period, and provide a critical juxtaposition with the literature. Five aneurysms were located in the posterior circulation, 8 were large-giant sized, 5 were calcified/thrombosed. One presented as a dissecting-fusiform aneurysm, 9 ranked among wide neck aneurysms. Eight lesions were excluded by neck clipping (5 necessitating coil extraction); 1 requiring adjunct CE. The dissecting-fusiform aneurysm was resected with reconstruction of the parent artery using a radial artery graft. Three lesions were treated with flow alteration (parent artery occlusion under bypass protection). Mean interval coiling-surgery was 4.6 years (range 0.5-12 years). Overall, 10 aneurysms were successfully excluded; 2 lesions treated with flow alteration displayed partial thrombosis, progressing over time. Outcome was good in 8 and poor in 4 patients (2 experiencing delayed neurological morbidity), and mean follow-up was 24.3 months. No mortality was encountered. Microsurgery as a last resort for precoiled CIAs can provide-in a majority of cases-a definitive therapy with good outcome. Since repeat coiling increases the complexity of later surgical treatment, we recommend for this subgroup of aneurysms a critical evaluation of CE as an option for re-treatment.
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Affiliation(s)
- Ariyan Pirayesh
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan.
| | - Nakao Ota
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Kosumo Noda
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Ioannis Petrakakis
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
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Kutty RK, Kumar A, Yamada Y, Tanaka R, Kannan S, Ravisankar V, Musara A, Miyatani K, Higashiguchi S, Takizawa K, Kawase T, Kato Y. Management of Recurrent Aneurysms after Endovascular Coiling: A Fujita Experience. Asian J Neurosurg 2020; 14:1151-1156. [PMID: 31903355 PMCID: PMC6896644 DOI: 10.4103/ajns.ajns_105_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Microsurgical clipping and Endovascular coiling (EC) are both effective alternatives in the management of intracranial aneurysms. EC has been shown to be associated with the risk of recurrent aneurysm (RA) growth. Considering the minimally invasive nature of this procedure, the management of intracranial aneurysms has been skewed toward EC, especially in the developed world. In this scenario, there has been an upsurge of RAs after EC. Since the optimal management of these RAs has not been defined, they pose a unique challenge to the treating surgeons. Aims and Objectives: The aim of this study is to elucidate the optimal management of RAs after EC. Materials and Methods: Medical records of all patients who underwent surgery for RAs were reviewed from the period January 2014 to March 2019. The demographic and angiographic patterns of the patients and operative techniques and complications were studied. The outcome was dichotomized into good and bad depending on the Glasgow outcome scale (GOS). Results: There were four cases of RAs operated in our institution between the above-mentioned period. There were varied differences between the initial coiling and time to recurrences. All four patients were operated under neuromonitoring. Three underwent clipping and one patient underwent clipping with bypass. All four patients had good outcome with a GOS of 5/5. Conclusion: Operations for RAs constitute many technical challenges and require a lot of expertise. Such surgeries are recommended in high-volume centers, with sufficient experience in both clipping and cerebral bypass.
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Affiliation(s)
- Raja K Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Ambuj Kumar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yasuhiro Yamada
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Satish Kannan
- Department of Neurosurgery, MGM Hospital, Chennai, Tamil Nadu, India
| | | | - Aaron Musara
- Department of Neurosurgery, College of Health Sciences, Harare, Zimbabwe
| | - Kyosuke Miyatani
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Saeko Higashiguchi
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Redcross Hospital, Hokkaido, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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Current Management of Mirror Distal Anterior Cerebral Artery Aneurysms in Association with Multiple Aneurysms: Case Report with Literature Review. World Neurosurg 2019; 130:324-334. [DOI: 10.1016/j.wneu.2019.07.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
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8
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Predictors for ophthalmic segment aneurysms recanalization after coiling and flow diverter embolization in 6- and 12-month follow-up. J Clin Neurosci 2019; 68:151-157. [PMID: 31307854 DOI: 10.1016/j.jocn.2019.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 05/23/2019] [Accepted: 07/05/2019] [Indexed: 11/22/2022]
Abstract
Carotid-ophthalmic aneurysms are indication for endovascular treatment. Coil embolization is associated with a high recanalization rate and thus usage of flow diverter (FD) could constitute the treatment of choice. Although implementation of FD is very effective, it carries a significant risk of complications. The goal of our study was to find a radiological recanalization marker in order to facilitate decision process which would result in fewer treatment-related complications and in this way, to personalize endovascular therapy. We made a retrospective analysis of seventy-five patients with saccular carotid-ophthalmic aneurysms treated endovascularly. Morphometric measurements were performed in CTA 3D aneurysm models. The aneurysm size and volume were measured on the base of digital subtraction angiography (DSA) images. The treatment effectiveness was determined visually using the modified Raymond Roy classification after embolization and on the 6- and 12-month follow-up DSA. Statistica 13.1 software was used. Multivariate analyses showed that the aneurysm neck size (OR 2.51; 95%CI: 1.20-5.26), aspect ratio (OR 2.60; 95%CI: 1.27-5.21) and neck to parent artery ratio (OR 2.68; 95%CI: 1.26-5.70) were risk factors for carotid-ophthalmic aneurysms recanalization after 6 months. Of those factors, aneurysm neck size remained the only significant risk factor for carotid-ophthalmic aneurysms recanalization after 12 months (OR 5.23, 95%CI: 1.71-15.93). Various factors seem to influence recanalization. Preoperatively, if the above-mentioned predictors of recanalization are present, coiling is burdened with a high recanalization rate. In those cases, FD embolization should be considered.
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9
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Balaji A, Rajagopal N, Yamada Y, Teranishi T, Kawase T, Kato Y. A Retrospective Study in Microsurgical Procedures of Large and Giant Intracranial Aneurysms: An Outcome Analysis. World Neurosurg X 2019; 2:100007. [PMID: 31218282 PMCID: PMC6580892 DOI: 10.1016/j.wnsx.2019.100007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/24/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Intracranial aneurysms are considered large if >10 mm and giant if >25 mm. The risk of aneurysmal rupture compounds with increase in size of the aneurysm, thus, warranting appropriate intervention. In this study, we have analyzed the outcome and effectiveness of microsurgical procedures in large and giant aneurysms. METHODS A retrospective analysis of all the patients who underwent microsurgical procedures for large and giant cerebral aneurysms from 2014-2018 in our institute was conducted. There were a total of 52 patients, in which direct clipping was performed in 42 (80.7%) patients, proximal trapping in 3 (5.7%) patients, trapping with bypass in 3 (5.7%) patients, suction decompression in 3 (5.7%) patients, and 1 (1.9%) patient underwent surgical reconstruction. RESULTS Among the 52 patients, in the postoperative period, 1 (1.9%) patient became comatose, 1 (1.9%) patient developed hemiplegia, 1 (1.9%) patient had a transient hemiparesis, and 1 (1.9%) patient had transient lower cranial nerve palsy. Two (3.8%) patients had chronic subdural hematoma during the 3-month follow-up. There was no mortality in our series. CONCLUSIONS There are several treatment strategies available to manage large and giant cerebral aneurysms. In this study, we had minimal morbidity (3.8%), favorable outcome (96.1%), and no mortality. Therefore, we would like to conclude that appropriate microsurgical procedures, in experienced hands, can be considered as first line in the management for large and giant intracranial aneurysms, especially those with complex anatomy, wide neck, mass effect, partial thrombosis, and the presence of critical perforating vessels from the aneurysm wall.
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Key Words
- 3D, 3-Dimensional
- BTO, Balloon test occlusion
- Bypass
- CFD, Computational fluid dynamics
- CTA, Computed tomography angiogram
- Clipping
- DIVA
- DIVA, Dual image video angiography
- DSA, Digital subtraction angiography
- GOS, Glasgow Outcome Scale
- Giant
- ICA, Internal cerebral artery
- ICG, Indo-cyanine green
- Intracranial aneurysm
- MEP, Motor evoked potential
- MRI, Magnetic resonance imaging
- OA, Occipital artery
- Outcome
- PICA, Posterior inferior cerebellar artery
- RSD, Retrograde suction decompression
- Trapping
- VA, Vertebral artery
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Affiliation(s)
- Arun Balaji
- Department of Neurosurgery, Kovai Medical Centre and Hospital, Coimbatore, India
| | - Niranjana Rajagopal
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan
| | - Takao Teranishi
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Tsukasa Kawase
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Yoko Kato
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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Roy AK, Philipp LR, Howard BM, Cawley CM, Grossberg JA, Barrow DL. Microsurgical Treatment of Cerebral Aneurysms After Previous Endovascular Therapy: Single-Center Series and Systematic Review. World Neurosurg 2019; 123:e103-e115. [DOI: 10.1016/j.wneu.2018.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 01/01/2023]
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11
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Muskens IS, Hertgers O, Lycklama à Nijeholt GJ, Broekman MLD, Moojen WA. Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis. Neurosurgery 2018; 85:750-761. [DOI: 10.1093/neuros/nyy455] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022] Open
Abstract
Abstract
BACKGROUND
Long-term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment.
OBJECTIVE
To evaluate retreatment related outcomes.
METHODS
A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias.
RESULTS
Twenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95% confidence interval [CI]: 87.0-94.1) and a pooled mortality rate of 5.6% (95% CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95% CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95% CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95% CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95% CI: 11.4-92.7) and a pooled mortality rate of 9.3% (95% CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models.
CONCLUSION
Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate.
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Affiliation(s)
- Ivo S Muskens
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Center for Genetic Epidemiology, Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Omar Hertgers
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Marike L D Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter A Moojen
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
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12
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Nisson PL, Meybodi AT, Roussas A, James W, Berger GK, Benet A, Lawton MT. Surgical Clipping of Previously Ruptured, Coiled Aneurysms: Outcome Assessment in 53 Patients. World Neurosurg 2018; 120:e203-e211. [PMID: 30144619 DOI: 10.1016/j.wneu.2018.07.293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Occasionally, previously coiled aneurysms will require secondary treatment with surgical clipping, representing a more complicated aneurysm to treat than the naïve aneurysm. Patients who initially presented with a ruptured aneurysm may pose an even riskier group to treat than those with unruptured previously coiled aneurysms, given their potentially higher risk for rerupture. The objective of this study was to assess the clinical outcomes of patients who undergo microsurgical clipping of ruptured previously coiled cerebral aneurysms. In addition, we present a thorough review of the literature. METHODS A total of 53 patients from a single institution who initially presented with a subarachnoid hemorrhage and underwent surgical clipping of a previously coiled aneurysm between December 1997 and December 2014 were studied. Clinical features, hospital course, and preoperative and most recent functional status (Glasgow Outcome Scale score) were reviewed retrospectively. RESULTS The mean time interval from coiling to clipping was 2.6 years, and mean follow-up was 5.5 years (range, 0.1-14.7 years). Five patients (9.8%) presented with rebleed prior to clipping. Most patients (79.3%, 42/53) experienced good neurologic outcomes. Most showed no change (81%, 43/53) or improvement (13%, 7/53) in functional status after microsurgical clipping. One patient (2%) deteriorated clinically, and there were 2 mortalities (4%). CONCLUSIONS Microsurgical clipping of previously ruptured, coiled aneurysms is a promising treatment method with favorable clinical outcomes.
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Affiliation(s)
- Peyton L Nisson
- College of Medicine, University of Arizona, Tucson, Arizona, USA; Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Adam Roussas
- College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Whitney James
- Division of Neurosurgery, Banner-University Medical Center, Tucson, Arizona, USA
| | - Garrett K Berger
- College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Arnau Benet
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
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Wang WX, Xue Z, Li L, Wu C, Zhang YY, Lou X, Ma L, Sun ZH. Treatment Strategies for Intracranial Mirror Aneurysms. World Neurosurg 2017; 100:450-458. [PMID: 28131928 DOI: 10.1016/j.wneu.2017.01.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
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