Aneurysm clipping after partial endovascular embolization for ruptured cerebral aneurysms

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Subarachnoid hemorrhage from ruptured cerebral aneurysms requires timely and effective treatment.
• Two-stage treatment involving endovascular embolization followed by surgical clipping is a potential strategy.

Purpose of the Study:

• To evaluate the advantages and disadvantages of a two-stage treatment for ruptured cerebral aneurysms.
• To assess the safety and efficacy of partial embolization followed by clipping.

Main Methods:

• Retrospective review of 20 ruptured cerebral aneurysms treated with initial endovascular embolization using Guglielmi detachable coils.
• Subsequent surgical clipping was performed for 6 lesions where complete embolization was not achieved.

Main Results:

• Partial embolization effectively prevented rerupture in the subacute period.
• Complications occurred during clipping (visual acuity impairment, memory disturbance) but not with embolization.
• Coil extraction was necessary in 3 cases due to coil loops extending into the aneurysm neck, without observed complications.

Conclusions:

• Two-stage treatment is effective for preventing rerupture but presents challenges.
• Careful surgical planning is needed for clipping embolized aneurysms, especially large ones.
• Coil extraction may be required, necessitating meticulous technique to avoid vascular damage.