The study was aimed determine the criteria for treating cerebral aneurysms, ruptured
and
unruptured, suitable for endovascular Guglielmi detachable coiling (GDC) with least morbidity
and
mortality. We will discuss the importance of knowledge of the geometry of cerebral aneurysm
and
its impact on the results of coiling. We have treated 324 patients with cerebral aneurysms at the University of Illinois Hospital from May 1, 1994 to June 1997. During this period 139 patients were treated with GDC
and
185 patients were treated surgically. Of 139 patients treated with coils 54 patients with 54 aneurysms were ruptured
and
the remaining 85 patients with 90 aneurysms were unruptured. For initial 25 patients, the selection of aneurysms for coiling was random
and
the geometry of the aneurysm was not considered as an important factor in the selection for coiling, however, in the later series of 114 patients with 119 aneurysms were selected for coiling only when the geometry looked favorable in the angiogram. With time we realized that the
dome
/neck ratio more than or equal to 2/1
and
the diameter of the neck not ex-ceeding 5mm were most suitable for coiling. The initial series of 25 patients (May 1994 to February 1995) treated without taking geometry of the aneurysms as an important criteria for coiling led to high morbidity
and
mortality
and
less than 50% of these aneurysms were angiographically occluded at 6-month follow-up. In the second series of 114 patients (March 1995 to June 1997) with 119 aneurysms we had 0% mortality related to the coiling
and
only 1.8% permanent morbidity. We found complete aneurysm occlusion in 78% of the subarachnoid hemorrhage
and
76% of unruptured group when the
dome
/neck ratio was more than or equal to 2/1. However, the occlusion rate dropped to 50% when the
dome
/neck ratio was less than 2/1. This preliminary experience suggests that GDC is a safe technique with low mortality-morbidity for the treatment of intracranial aneurysms in appropriately selected patients. The percentage of complete occlusion of the aneurysm following tight
and
dense packing is strongly dependent on the geometry of the aneurysm
and
we conclude that the best results are achieved when the
dome
/neck ratio is more than or equal to 2/1.
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