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Surgically treated aneurysms previously coiled: lessons learned.
Erol Veznedaroglu1, Ronald P Benitez, Robert H Rosenwasser
1Division of Cerebrovascular and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital for Neuroscience, 909 Walnut Street 3rd Floor, Philadelphia, PA 19107, USA.
Neurosurgery
|January 28, 2004
Summary
Surgery for residual cerebral aneurysms after coil embolization presents challenges for neurosurgeons. Careful consideration of surgical techniques is crucial for managing these complex cases effectively.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Intravascular coil embolization is a common treatment for cerebral aneurysms.
- Long-term outcomes and potential complications, such as aneurysm refilling, require further investigation.
- Patients with residual aneurysms after coil embolization present unique surgical challenges.
Observation:
- This study reviewed 18 patients who underwent surgery for residual aneurysms post-coil embolization.
- Aneurysms were located in various cerebral arteries, including anterior communicating, posterior communicating, internal carotid, posteroinferior cerebellar, and middle cerebral arteries.
- One patient presented with aneurysm rupture, and another with cranial nerve palsy; others were identified during routine follow-up.
Findings:
- Fifteen aneurysms were treated with clipping, and three with wrapping due to technical difficulties.
- No major intraoperative complications occurred, and all patients recovered uneventfully.
- The presence of coils complicated aneurysm neck exposure and clipping, leading to incomplete obliteration in three cases.
Implications:
- Surgical management of cerebral aneurysms previously treated with coils is feasible but technically demanding.
- Neurosurgeons must be aware of the specific difficulties and potential pitfalls associated with re-treating coiled aneurysms.
- As coil embolization use increases, the incidence of patients requiring subsequent surgery for residual aneurysms is expected to rise.