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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
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Clipping versus coiling in unruptured anterior cerebral circulation aneurysms
Farrag Mohammad1,2, Takashi Horiguchi1, Katsuhiro Mizutani1
1Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
Surgical Neurology International
|April 8, 2020
Summary
Surgical clipping offers greater durability for unruptured intracranial aneurysms (UIAs), while endovascular coiling shows lower morbidity and shorter hospital stays. Both treatments are safe and feasible for UIAs.
Area of Science:
- Neurosurgery
- Interventional Neurology
- Vascular Neurology
Background:
- Unruptured intracranial aneurysms (UIAs) are prevalent, particularly in Japan.
- Treatment strategies for UIAs differ globally, with endovascular coiling favored in Western countries and surgical clipping in Japan.
Purpose of the Study:
- To compare the safety and efficacy of surgical clipping versus endovascular coiling for treating unruptured intracranial aneurysms (UIAs) in the anterior cerebral circulation.
- To evaluate postoperative angiographic and clinical outcomes for both treatment modalities.
Main Methods:
- Retrospective study of 200 patients with UIAs in the anterior cerebral circulation.
- Patients were treated with either surgical clipping (147 patients) or endovascular coiling (53 patients).
- Outcomes assessed included complete occlusion, aneurysm regrowth, ischemic events, modified Rankin Scale, and postoperative hospital stay.
Main Results:
- Complete occlusion rates were significantly higher with clipping (78.9%) compared to coiling (18.8%).
- Aneurysm regrowth was more frequent after coiling (13.2%) than clipping (1.4%).
- While asymptomatic ischemic events were higher in the coiling group (24.5%), symptomatic complications and modified Rankin Scale deterioration were similar between groups. Clipping resulted in a longer hospital stay.
Conclusions:
- Both surgical clipping and endovascular coiling are safe and effective for treating UIAs.
- Clipping provides superior durability, whereas coiling offers lower morbidity and shorter hospitalization.
- A combined approach, leveraging the strengths of both clipping and coiling, is recommended for UIA management.
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