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[Subarachnoid hemorrhage caused by aneurysm rupture. Surgery or embolization?]
J C Marchal1, J P Lescure, S Bracard
1Service de neurochirurgie, hôpitaux urbains, Nancy, France.
Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1996
Summary
Endovascular treatment using detachable coils offers an alternative to neurosurgery for circle of Willis aneurysms. Patient selection for surgery versus endovascular therapy depends on factors like vasospasm and aneurysm location.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Surgery
Context:
- Traditionally, circle of Willis aneurysms necessitated neurosurgical intervention.
- Recent advancements introduced endovascular treatment with detachable coils, altering therapeutic paradigms.
- A study evaluated 140 patients treated between 1992 and 1994.
Purpose:
- To compare the efficacy and indications for surgical versus endovascular treatment of circle of Willis aneurysms.
- To analyze patient selection criteria for each treatment modality.
Summary:
- Out of 140 patients, 84 underwent surgery, 51 received endovascular treatment, and 5 had surgery post-endovascular intervention.
- Surgical candidates presented early, without vasospasm, with good Hunt and Hess grade, and anterior circle of Willis aneurysms.
- Endovascular candidates presented later, with vasospasm, poor Hunt and Hess grade, or vertebrobasilar aneurysms.
Impact:
- The study highlights the evolving treatment landscape for cerebral aneurysms.
- It provides insights into patient selection for neurosurgery versus endovascular techniques.
- Giant aneurysms present unique challenges for both surgical and endovascular approaches.