Related Experiment Videos
Coiling of recurrent and residual cerebral aneurysms after unsuccessful clipping
G Bavinzski1, V Talazoglu, M Killer
1Department of Neurosurgery, University of Vienna, Medical School, Austria.
Insights
Guglielmi detachable coils (GDCs) offer a viable alternative for treating recurrent or residual aneurysms after failed surgical clipping. This endovascular technique achieved high occlusion rates, presenting a less invasive option than reoperation.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Recurrent and residual aneurysms after surgical clipping pose significant management challenges.
- Reoperation for these complex cases carries substantial risks.
- Endovascular techniques are increasingly explored as alternatives to open surgery.
Observation:
- Four patients with post-surgical aneurysms were treated with Guglielmi detachable coils (GDCs).
- Three patients had recurrent aneurysms, one had a residual aneurysm.
- Two patients experienced subarachnoid hemorrhage (SAH) years after initial treatment.
Findings:
- GDC treatment resulted in complete occlusion in three aneurysms and >90% occlusion in one.
- Patient outcomes varied: one good, one fair, and one death among poor-grade patients.
- One good-grade patient maintained an excellent postoperative condition.
Implications:
- GDC treatment represents a feasible alternative to reoperation for select patients with complex aneurysms.
- Endovascular coiling may offer improved outcomes and reduced risks compared to repeat surgical interventions.
- Further research is warranted to establish the long-term efficacy and safety of GDCs in this patient cohort.
Abstract:
We treated four patients with 3 recurrent and 1 residual aneurysm after surgical clipping by using Guglielmi detachable coils (GDCs). Three subjects presented after a second subarachnoid hemorrhage (SAH) occurring between 10 and 25 years after the first bleeding. Early postoperative angiography of the fourth patient showed an incompletely clipped aneurysm. In three poor grade patients we observed one good outcome, one fair result and one death due to the sequelae of SAH. One good grade patient remained in excellent condition postoperatively. Three aneurysms were totally occluded and in one a more than 90% occlusion was achieved with GDCs. We consider the treatment with GDC a viable alternative to reoperation in all patients with recurrent or residual aneurysms following failed attempt at surgical obliteration.