Microsurgical Management of Incomplete Coiled and Recurrent Aneurysms

Abstract

We determined microsurgical techniques for treating previously coiled aneurysms and report the outcomes. Twelve symptomatic patients with incomplete or recurrent aneurysms were managed microsurgically. The necks of five incomplete coiled aneurysms were clipped (mean time to microsurgery, 35.5 days), and one was treated with bypass surgery. One of the patients who underwent neck clipping had bleeding during dissection of the aneurysm. Six patients who had recurrent aneurysms underwent microsurgery at a mean of 778 days after initial complete embolization. Two fully recovered from transient ischemic symptoms that occurred after microsurgery and the coil became extruded in one other patient. The necks of the aneurysms were clipped in five of these patients and the aneurysm was wrapped in one. Direct clipping is the preferred microsurgical treatment for coiled aneurysms. The necks of such aneurysms should be carefully clipped according to the timing of the surgery and the status of the aneurysm.