Microsurgical treatment for the recurrent cerebral aneurysm initially treated using coil embolization

Abstract

Objective: Microsurgical treatment could be a good alternative for the treatment of recurrent cerebral aneurysm after coil embolization. The purpose of this study was to present our experience of microsurgical treatment for recurrent cerebral aneurysm previously treated using coil embolization. Methods: From June 2012 to May 2019, 34 patients consecutively received microsurgical treatment for a recurrent cerebral aneurysm previously treated using coil embolization after it ruptured. Results: Of the 34 patients with aneurysm, 33 had the aneurysm located in the anterior circulation. The most common location was the anterior communicating artery (13 cases). Immediate radiologic outcome at coil embolization was completed (n=6), residual neck (n=26), and residual sac (n=2). The reason for microsurgical treatment included rebleeding (n=12), persistent residual sac (n=1), and recurrence on follow-up study (n=21). Rebleeding occurred within 10 days after coil embolization in 10 cases, and the other 2 were due to regrowth. In the 20 recurred and saccular aneurysms, coil compaction was present in 11 aneurysms and regrowth in 9 aneurysms. Simple neck clipping (n=29) and clipping with coil mass extraction (n=3) was possible in the saccular aneurysms. The blood blister like aneurysm (n=2) were treated using bypass and endovascular internal carotid artery trapping. In the follow-up study group after microsurgical treatment there were no severe complications due to the treatment. Age, cause of retreatment, and modified Rankin Scale before microsurgery were associated with good outcome (p<0.001). Conclusions: Microsurgical treatment may be a viable and effective option for treating recurrent aneurysms previously treated by endovascular techniques.

Surgical Treatment Strategies for Residual or Recurrent Intracranial Aneurysms Following Endovascular Embolization

“…5 There is no consensus on whether to remove the spring coil during aneurysm clipping. [8][9][10]22 Some scholars have used different combinations of clips or specially designed clips to clip the recurrent aneurysm after embolization, thereby avoiding the need to remove the spring coil. 21,22 For difficult-toclip recurrent aneurysms during surgery, some scholars have performed aneurysm wrapping.…”

“…[8][9][10]22 Some scholars have used different combinations of clips or specially designed clips to clip the recurrent aneurysm after embolization, thereby avoiding the need to remove the spring coil. 21,22 For difficult-toclip recurrent aneurysms during surgery, some scholars have performed aneurysm wrapping. 8 In this study, 3 cases were treated by clipping the aneurysm by removing the spring coil, and one case was switched to extracranial-intracranial bypass due to the difficulty of removing the spring coil for clipping.…”

“…However, for late-stage recurrent aneurysms, the spring coil is closely adhered to the aneurysm wall, especially when involving the neck, forcefully removing the spring coil may cause neck rupture and lead to serious consequences 5 . There is no consensus on whether to remove the spring coil during aneurysm clipping 8–10,22 . Some scholars have used different combinations of clips or specially designed clips to clip the recurrent aneurysm after embolization, thereby avoiding the need to remove the spring coil 21,22 .…”

Intentional staged clipping following previous coil embolization of ruptured aneurysm with a branch arising from the neck: technical note

“…Generally, when considering retreatment, it should be recognized that recurrence of an aneurysm can have two distinct causes: aneurysm regrowth and coil compaction. Aneurysm regrowth is characterized by a change in the morphology of the aneurysm relative to its initial structure (9). Coil compaction is a change in the configuration of the coil compared with the baseline appearance of the coil mass after CE, without changes in the morphology of the aneurysm itself (9).…”

“…Aneurysm regrowth is characterized by a change in the morphology of the aneurysm relative to its initial structure (9). Coil compaction is a change in the configuration of the coil compared with the baseline appearance of the coil mass after CE, without changes in the morphology of the aneurysm itself (9). It is important to differentiate between the two types of recurrence because some previous reports have found that aneurysm regrowth is more dangerous than coil compaction (2,11).…”