Combined treatment of cerebral aneurysms with utilization of clipping and coiling techniques

Cerebral aneurysm clipping is a widely used and accepted treatment option. However, in some patients in severe condition (IV and V WFNS grade), with aneurysms of basilar and vertebral part of the arterial circulation and with high general surgical risk, direct aneurysm surgery can be a real technical and clinical problem. Therefore, low risk of coiling procedures gain more and more support. Out of 218 patients with diagnosed aneurysms, 60 were selected for coiling treatment, and 15 patients with multiple aneurysms were treated with both procedures. Special attention has to be addressed to the selection of patients for coiling procedures, especially in the cases when aneurysmal neck is directed accordingly to the main blood stream. The follow-up of the treatment effects is necessary. In the cases with growing aneurysms clipping is recommended. In the cases with stable size of the aneurysmal sack and visible coils compression, the coiling procedure is repeated. The coiling procedures can offer a valuable treatment option for selected patients. However, the maintenance of permanent occlusion of the aneurysm sack after coiling gives rise to some controversy.