Microsurgical technique for previously coiled aneurysms.

Area of Science:

• Neurosurgery
• Endovascular Surgery
• Cerebrovascular Disease

Background:

• Endovascular coiling for intracranial aneurysms has increased since 1991.
• This has led to a rise in residual and recurrent aneurysms requiring microsurgical intervention.
• Microsurgical occlusion is a critical treatment option for previously coiled aneurysms.

Purpose of the Study:

• To retrospectively analyze outcomes of microsurgical treatment for previously coiled intracranial aneurysms.
• To identify factors influencing the difficulty and outcomes of these complex neurosurgical procedures.
• To evaluate the safety and efficacy of microsurgical occlusion versus other options.

Main Methods:

• Retrospective analysis of 81 patients with 82 previously coiled aneurysms treated microsurgically.
• Data collected from two Finnish Neurosurgical University Hospitals between July 1995 and August 2009.
• Analysis included aneurysm location, timing of surgery (early vs. late), coil removal, and clinical outcomes.

Main Results:

• Good clinical outcome (71/81 patients, 88%) was achieved, but 6 patients died.
• Complete or partial coil removal was more difficult in late surgery (P<0.001).
• Poor outcomes were associated with intraoperative rupture, larger aneurysm size, and posterior circulation location.

Conclusions:

• Complete microsurgical occlusion of residual coiled aneurysms is high-risk, especially for large/giant aneurysms.
• Referral to dedicated neurovascular centers is recommended to minimize complications.
• Bypass procedures may be optimal for complex lesions, particularly in the posterior circulation.