2009 Volume 37 Issue 6 Pages 443-446
The rate of endovascular coiling as a treatment of cerebral aneurysm is increasing in Japan. However, the results are not necessarily favorable in cases of large aneurysms, and retreatment is required in many cases. Based on this, clipping should be initially considered as curative treatment for large cerebral aneurysm. In cases of critical (Hunt & Kosnik Grade 4 or 5), extensively ruptured brain aneurysm, direct surgery in the acute phase is not straightforward, and the outcomes are not always favorable.
However, some cases follow favorable courses when they pass the acute phase. In extensively ruptured brain aneurysm, endovascular treatments can be performed in a minimally invasive way, and the risk of rebleeding is surprisingly low even with partial occlusion. We experienced 2 cases of extensively ruptured brain aneurysm, successfully treated with partial occlusion for the aneurysm by interventional radiosurgery performed in the acute phase and surgical clipping in the chronic phase.
Clipping after endovascular coiling can be difficult to perform when the coil is not removed and is densely filled. Therefore, it is preferable to perform partial occlusion without filling the neck of the aneurysm with the coil.
