Introduction: The purpose of this study was to describe efficacy and safety of additional microsurgical retreatments performed after the first coil embolization, and to report our experiences of microsurgical retreatment.
Methods: From January 2005 to December 2011, we treated 372 patients with intracranial aneurysms by coil embolization. Among them, 12 patients (3.1%) underwent microsurgical retreatment due to incomplete coil embolization and long-term coil compaction. Most patients (68%) presented initially with subarachnoid hemorrhage.
Results: All twelve patients were located anterior circulation, The most common retreated aneurysms were located in the posterior communicating artery (54%). Eight patients had incompletely coiled aneurysms and four patients had long-term coil compaction. The mean time to recur was 15 months. Overall, 8 aneurysms were clipped directly without coil removal, 3 aneurysms were clipped with complete coil removal, and one giant aneurysm were treated with trap-bypass. Two patient who had been at poor grade at admission experienced permanent neurological morbidity, and the 10 patients had good outcomes.
Conclusions: Aneurysm clipping following a previous coiled aneurysms is a rare but not so exceptional a situation for experienced neurovascular center. With the increase of endovascular treatment, Cerebrovascular neurosurgeons will be faced with the treatment of previously coiled aneurysms. Complete microsurgical occlusion of the residual or regrowth of coiled aneurysm is challenge but safe and permanent treatment option with acceptable outcomes in properly selected cases.
Patient Care: Complete microsurgical occlusion of the residual or regrowth of coiled aneurysm is challenge but safe and permanent treatment option with acceptable outcomes in properly selected cases.
Learning Objectives: 1) Identify an efficacy and safety of microsurgical retreatment of previously coiled aneurysms