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

• Published in: Journal of cerebrovascular and endovascular neurosurgery Vol. 22; no. 3; pp. 165 - 175
• Main Authors: Lee, Juwhan, Kim, Sung-Tae, Shim, Yong Woo, Back, Jin Wook, Ko, Jung Hae, Lee, Won Hee, Paeng, Sung Hwa, Pyo, Se Young, Heo, Young Jin, Jeong, Hae Woong, Jeong, Young Gyun
• Format: Journal Article
• Language: English
• Published: Korea (South) KSCVS and KoNES 01-09-2020; 대한뇌혈관외과학회
• Subjects: Original; 신경외과학; Microsurgery; Recurrence; Retreatment; Intracranial aneurysm
• ISSN: 2234-8565; 2287-3139
• DOI: 10.7461/jcen.2020.22.3.165

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.
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.
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).
Microsurgical treatment may be a viable and effective option for treating recurrent aneurysms previously treated by endovascular techniques.