THE EFFICACY OF ENDOSACCULAR ANEURYSM OCCLUSION IN ALLEVIATING NEUROLOGICAL DEFICITS PRODUCED BY MASS EFFECT

Endovascular obliteration of intracranial aneurysms with preservation of the parent artery (endosaccular occlusion) has been advocated for p atients who fail or are excluded from surgical clipping and cannot und ergo Hunterian ligation therapy. To clarify the effect that endosaccul ar occlusion has on the presenting neurological signs, 26 patients wit h aneurysms and symptoms related to mass effect who underwent this the rapy were followed for a mean of 60 months. Only patients with objecti ve neurological deficits who had not suffered a hemorrhage were includ ed in this series. Response to therapy was classified into one of thre e groups: ''resolved,'' if the patient had complete resolution of pres enting signs; ''improved,'' if significant and sustained improvement w as recorded in the neurological examinations, and ''unchanged,'' if no change was observed. Thirteen patients (50%) were classified as resol ved, 11 (42.3%) as improved, and two (7.7%) as unchanged. A comparison of patients classified as resolved with those who were improved revea led that the former group had less wall calcification (30% vs. 60%) an d a shorter duration of symptoms. Patients with neurological sign reso lution (62%) were more likely to have totally occluded aneurysms on la te follow-up arteriograms than those who had improvement (28%) or were unchanged (0%). This study suggests that endosaccular embolization th erapy can improve or alleviate presenting neurological signs unrelated to hemorrhage or distal embolization in the majority of cases.