Intraaneurysmal Embolization for Middle Cerebral Aneurysm

Abstract

We review intraaneurysmal embolization of Guglielmi detachable coils (GDCs) for middle cerebral artery aneurysm, which is thought to be relatively easy for surgical clipping and relatively difficult for embolization. The subjects of this study are 15 middle cerebral aneurysms in 14 patients treated by intraaneurysmal GDC embolization between January 1996 and December 1998. There were 2 males and 12 females with an average age of 70.6 years. Six aneurysms were ruptured and the others were unruptured. All the ruptured aneurysms were treated in their acute stage with Hunt and Kosnik grades II in 1, III in 1, IV in 3, and V in 1. The patient with H & K grade II was accompanied by idiopathic thrombocytopenic purpura. Spinal drainage was performed in all patients with ruptured aneurysm, and a tissue-type plasminogen activator was administered via the drainage in 4 patients. Glasgow outcome scale at discharge was good recovery in 2, moderate disability in 1, severe disability in 1 and dead in 2.
In the patients with unruptured aneurysm, 3 patients were accompanied with renal dysfunction. One aneurysm was treated by neck plasty technique. No patients aggravated clinically. There were no complications either in ruptured and unruptured cases.
Although intraaneurysmal GDC embolization is not suitable for middle cerebral artery aneurysms, it is indicated when surgical difficulties are considered such as patients of advanced age, patients with poor grade, and patients with systemic disease.