Microsurgery for Previously Coiled Aneurysms: Experience With 81 Patients

摘要: BACKGROUND: Residual and recurrent intracranial aneurysms after endovascular treatment with Guglielmi detachable coils may necessitate a microsurgical occlusion. OBJECTIVE: To analyze the technique describe how location, morphology, appearance of coiled aneurysm affect technique. METHODS: We retrospectively analyzed 81 patients 82 previously treated microsurgically at 2 Finnish neurosurgical university hospitals in Helsinki Kuopio between July 1995 August 2009. Seven videos were selected to demonstrate strategy various locations. RESULTS: Fifty-eight (71%) located anterior circulation 24 (29%) posterior circulation. Fifteen operated on within first month (early surgery) coiling, whereas 66 later (late surgery). Complete or partial removal during surgery facilitate clipping, but is significantly (P < .001) more difficult accomplish late surgery. Removal also increase chance poor outcome. Chance outcome increased intraoperative rupture, size aneurysm, location. Good clinical (same better condition 3 months was achieved 71 (88%). After microsurgery, 4 severely disabled 6 died, them because condition. CONCLUSION: occlusion residual possible. However, large giant direct microsurgery challenging high-risk procedure, we recommend that these be referred dedicated neurovascular center minimize surgical complications. Even experienced hands, use different bypass procedures best option for demanding growing lesions, especially those