Microsurgery for Previously Coiled Aneurysms: Experience With 81 Patients

Romani, Rossana; Lehto, Hanna; Laakso, Aki; Horcajadas, A.; Kivisaari, Riku; Fraunberg, Mikael von und zu; Niemelä, Mika; Rinne, Jaakko; Hernesniemi, Juha

doi:10.1227/neu.0b013e3181fd860e

Cited by 45 publications

(49 citation statements)

References 37 publications

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“…The feasibility of this procedure depends on several factors, including the time interval between the coiling procedure and microsurgical clipping, the position of the coils within the aneurysm, and the space available at the base of the aneurysm for clip placement. 1,21,27 Technical difficulties attributed to the coils present in the aneurysmal sac and neck are frequently encountered, making it difficult to properly clip the aneurysm and sometimes requiring removal of such coils. 9,11,25 The removal of coils for clip placement carries high morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective study that included 82 previously coiled aneurysms, Romani et al reported a similar rate (94%) of complete occlusion after surgical clipping. 21 Waldron et al reported that 32 of 33 (97%) previously coiled aneurysms were completely occluded without residual filling after microsurgical clipping. 27 Other smaller studies reported occlusion rates ranging from 83% to 100%.…”

Section: 21mentioning

confidence: 99%

“…Romani et al reported complications leading to major morbidity and mortality in 10 of 81 patients (12%). 21 Zhang et al reported complications in 7 of 38 patients (18%). 29 Waldron et al reported that the rate of surgical mortality was 7%, the permanent neurological morbidity rate was 2%, and the remaining 39 patients (91%) had good outcomes.…”

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confidence: 99%

“…The literature on clipping of previously coiled intracranial aneurysms is still limited, with few institutions reporting their initial experiences. 1,15,21,27 With the growing population of patients harboring recurrent aneurysms, the need for retreatment is growing. More studies are required to evaluate the strategies that should be implemented in the management of recurrent aneurysms.…”

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confidence: 99%

“…Similarly, Romani et al found that larger coiled aneurysms and aneurysms in the posterior circulation had worse outcomes after microsurgical clipping. 21 There are several endovascular treatments that can be used in the management of recurrent, previously coiled aneurysms. The major options include recoiling, stenting, stent-assisted coiling, and flow diversion.…”

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confidence: 99%

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Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients

Daou

Chalouhi

Starke

et al. 2016

JNS

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OBJECTIVE With the increasing number of aneurysms treated with endovascular coiling, more recurrences are being encountered. The aim of this study was to evaluate the efficacy and safety of microsurgical clipping in the treatment of recurrent, previously coiled cerebral aneurysms and to identify risk factors that can affect the outcomes of this procedure. METHODS One hundred eleven patients with recurrent aneurysms whose lesions were managed by surgical clipping between January 2002 and October 2014 were identified. The rates of aneurysm occlusion, retreatment, complications, and good clinical outcome were retrospectively determined. Univariate and multivariate logistic regressions were performed to identify factors associated with these outcomes. RESULTS The mean patient age was 50.5 years, the mean aneurysm size was 7 mm, and 97.3% of aneurysms were located in the anterior circulation. The mean follow-up was 22 months. Complete aneurysm occlusion, as assessed by intraoperative angiography, was achieved in 97.3% of aneurysms (108 of 111 patients). Among patients, 1.8% (2 of 111 patients) had a recurrence after clipping. Retreatment was required in 4.5% of patients (5 of 111) after clipping. Major complications were observed in 8% of patients and mortality in 2.7%. Ninety percent of patients had a good clinical outcome. Aneurysm size (OR 1.4, 95% CI 1.08–1.7; p = 0.009) and location in the posterior circulation were significantly associated with higher complications. All 3 patients who had coil extraction experienced a postoperative stroke. Aneurysm size (OR 1.2, 95% CI 1.02–1.45; p = 0.025) and higher number of interventions prior to clipping (OR 5.3, 95% CI 1.3–21.4; p = 0.019) were significant predictors of poor outcome. An aneurysm size > 7 mm was a significant predictor of incomplete obliteration and retreatment (p = 0.018). CONCLUSIONS Surgical clipping is safe and effective in treating recurrent, previously coiled cerebral aneurysms. Aneurysm size, location, and number of previous coiling procedures are important factors to consider in the management of these aneurysms.

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