Abstract
Objective A limited series of patients with aneurysms were reviewed retrospectively to analyze strategies for integrating microsurgical and endovascular techniques in the management of complex, surgically incurable aneurysms.
Methods Since 1997, nine patients were managed with a multimodality approach comprising a total of 4 different combinations: (1) coiling after intentional reconstruction of aneurysm neck (n=4); (2) coiling of recurrent aneurysm after clipping (n=1); (3) coiling of aneurysm and parent artery after bypass procedures (n=1); (4) clipping of aneurysm after attempted and incomplete coiling (n=3).
Results Among 9 aneurysms treated with combined therapy,6 aneurysms were large or giant in size and 7 had fusiform, dissecting or multilobulated morphology. Complete angiographic obliteration was achieved in 8 aneurysms (88.9%). Overall,8 patients (88.9%) had good outcomes (Glasgow Outcome Scale score of 4 or 5; mean follow-up,43 mo). One patient had died, possibly due to accompanying silent basilar tip aneurysm rupturing. There were no treatment-associated mortality or severe morbidity.
Conclusion As for complex, surgically in-curable aneurysms, endovascular coiling should be artistically combined with microsurgical clipping and revascularization. Among combined strategies, the intentional reconstruction of aneurysm neck followed by coil embolization, and clipping after attempted and incomplete coiling should be more than often encouraged for these complex aneurysms.
