Hybrid Microsurgical and Endovascular Approach in the Treatment of Multiple Cerebral Aneurysms: an Illustrative Case Series in Correlation with Literature Data

Abstract

Contemporary cerebral aneurysm treatment has advanced due to the expansion of microsurgical and endovascular techniques having different advantages and restraints. However, some aneurysms cannot be effectively treated by a single method alone due to their specific anatomy, location, complexity, and/or multiplicity. Subsequently, multiple aneurysms sometimes necessitate a hybrid strategy integrating both methods. The study aims were to discuss indications, possibilities, and challenges of a hybrid strategy in the decision making and treatment of multiple intracranial aneurysms. A single-institution illustrative case series of multiple intracranial aneurysm patients treated by a hybrid approach was analyzed and management outcome discussed and correlated with literature data. Following the treatment, both patients from our case series recovered well, having complete and stable aneurysmal occlusion with no relapse and no postoperative procedure-related complications or long-lasting neurological symptoms. In conclusion, a hybrid approach is advised as a treatment option for multiple cerebral aneurysms when a single modality is insufficient to bring satisfactory results. It may be a suitable and safe addition to an assortment of treatments pledging clinical improvement and enabling positive management outcome in patients with ruptured and non-ruptured multiple cerebral aneurysms.

Combined endovascular and microsurgical treatment of multiple cerebral aneurysms

“…Результати хірургічного лікування аневризм головного мозку значно поліпшилися за останні роки завдяки розвитку та впровадженню сучасних методів як ендоваскулярного, так і мікрохірургічного лікування [1]. Однак тривають дискусії щодо того, яку стратегію обрати в лікуванні множинних церебральних аневризм (МЦА) [2].…”

Endovascular treatment of multiple intracranial aneurysms

“…The presence of multiple aneurysms represents a higher risk than does a single aneurysm, because there is a higher associated complication rate arising from both the hemorrhage and any treatment in patients with multiple cerebral aneurysms which involve complex management issues. [1][2][3][4] An asymptomatic untreated aneurysm may carry a higher risk of rupture during the perioperative period when surgical intervention is performed for the treatment of a ruptured aneurysm. [5][6][7] Rinne et al [8] reported a significantly poorer 1-year outcome of 302 patients with multiple intracranial aneurysms compared with patients harboring single intracranial aneurysms after surgical clipping, with a management mortality of 24% in patients with multiple aneurysms compared with 20% in patients with single aneurysms.…”

Editorial: Hybrid (combined endovascular and microsurgical) treatments for cerebrovascular diseases

“…In select cases, a multimodality approach may be needed utilizing both endovascular and microsurgical techniques. For instance, an endovascular aneurysm treatment combined with minimally invasive endoscopic hematoma evacuation ( 5 ) or combined clipping/coiling procedures can be used to streamline treatment of a ruptured aneurysm with significant mass effect from the hematoma ( 6 , 7 ). In addition, microsurgical creation of an extra-intracranial bypass in combination with endovascular aneurysm obliteration may be an alternative for more complex morphologies ( 8 – 11 ).…”