Surgically treated aneurysms previously coiled: lessons learned.

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Cerebrovascular Surgery

Background:

• Intravascular coil embolization is a common treatment for cerebral aneurysms.
• Long-term outcomes and complications, such as aneurysm refilling, require further investigation.
• Patients with residual aneurysms after coil embolization present unique surgical challenges.

Purpose of the Study:

• To describe the surgical management of residual cerebral aneurysms following coil embolization.
• To evaluate the outcomes and identify challenges in re-treating these aneurysms.

Main Methods:

• A retrospective review of 18 patients who underwent surgery for residual aneurysms after coil embolization.
• Aneurysms were located in various cerebral arteries, including anterior communicating, posterior communicating, internal carotid, posteroinferior cerebellar, and middle cerebral arteries.
• Surgical techniques included clipping (15 patients) and wrapping (3 patients).

Main Results:

• No major complications were reported, with all patients experiencing uneventful recoveries.
• The presence of coils complicated aneurysm neck exposure and clipping.
• Incomplete neck obliteration occurred in three patients due to the presence of coils.

Conclusions:

• Surgical clipping of cerebral aneurysms previously treated with coils is technically demanding.
• The increasing use of coil embolization will lead to a greater number of patients requiring re-treatment.
• Neurosurgeons must be prepared for the specific difficulties and potential pitfalls associated with re-operating on coiled aneurysms.