NEUROSURGICAL MANAGEMENT OF CEREBRAL ANEURYSMS FOLLOWING UNSUCCESSFULOR INCOMPLETE ENDOVASCULAR EMBOLIZATION

Modern endovascular techniques permit treatment of intracranial aneury sms in many circumstances when surgery is associated with significant morbidity. Occasionally, embolization of aneurysms is unsuccessful or incomplete or followed by complications, in which case surgical manage ment is required. Since 1986, 196 patients have undergone embolization of intracranial aneurysms at the authors' institution and 21 (11%) re quired subsequent surgical treatment. Attempted embolization failed in five patients (Group A). Ten patients (Group B) had only partial occl usion of the aneurysm or demonstrated recanalization on follow-up stud ies. Eight of these Group B patients underwent embolization with Gugli elmi detachable coils (GDCs), representing 5.7% of the 141 GDC-treated patients in this experience. Surgical treatment in these two groups c onsisted of clipping (eight cases), surgical parent vessel occlusion ( one case), and parent vessel occlusion with extracranial-intracranial bypass (six cases). Fourteen (93%) of the 15 patients in these two gro ups had an excellent or good outcome with complete aneurysm occlusion. Six patients underwent surgery to treat complications related to the endovascular procedure (Group C). Of these, four patients had neurolog ical improvement compared to their preoperative state, and two died. T his series of cases demonstrates that surgical treatment of aneurysms is usually possible with good results following incomplete embolizatio n and emphasizes the need for close and continued neurosurgical involv ement in the endovascular management of intracranial aneurysms.