Hybrid Neurosurgery for Complex Cerebral Aneurysms

Abstract

  Complex cerebral aneurysms remain difficult to cure even with state‒of‒the‒art cerebral endovascular treatment and craniotomy, and a breakthrough in treatment is awaited. The purpose of this study was to investigate the therapeutic effect and safety of hybrid neurosurgery, which combines direct surgery and endovascular surgery for difficult‒to‒treat aneurysms. Between April 2003 and December 2017, a total of 1140 cases of cerebral aneurysm were treated in our department. Of these patients, the 10 who were treated with hybrid neurosurgery were included in this study. The subjects were 8 women and 2 men with an average age of 59.9 years (27‒72 years). The aneurysms affected the internal carotid artery in 6 cases (the ophthalmic segment in 2 cases, and the cavernous segment in 4), the vertebral artery in 3 cases, and the posterior cerebral artery in 1 case. The average maximum diameter of the aneurysm was 18.2 mm (4.5‒30 mm). In direct surgery, 6 patients underwent high blood flow bypass using the radial artery and 4 underwent low blood flow bypass using the superficial temporal or occipital artery, and internal trapping was then performed by endovascular surgery or aneurysm coil embolization. Complete obliterations were achieved in all cases. Exacerbation of postoperative symptoms was observed in only one case (preoperative modified Rankin Scale [mRS] 0 → postoperative mRS 1). The median follow‒up period was 123.5 months (32 to 184 months). There was no recurrence in any of the 10 cases and mRS scores were 0‒1 in 8 cases, 2 in 1 case, and 3 in 1 case. These results suggest that hybrid neurosurgery is a highly effective and safe treatment for difficult‒to‒treat aneurysms.