MICROSURGICAL MANAGEMENT OF A COMPLICATED ANEURYSMAL ENDOVASCULAR EMBOLIZATION WITH GDC COIL - A CASE-REPORT

We present a case involving a microsurgical approach to solving the pr oblem of a medial cerebral artery (MCA) occlusion occuring after GDC c oiling of an internal cerebral artery (ICA) bifurcation aneurysm in a 40 year old woman. We describe the clinical course of the case and dis cuss technical possibilities and risks of clipping a coiled aneurysm. One key to success is awareness of changes in the aneurysm's propertie s after coiling. With loss of elasticity the aneurysm had the effect o f a tumor fixed on the vessel. The apposition of the aneurysm to the w all of the vessel, as well as the aneurysm's rigidity and increase of intracranial pressure after subarachnoideal hemorrhage (SAH), may lead to occlusion of the vessel. In cases of an mandatory operation due to the occlusion of a main arterial stem after coiling, it is primarily crucial to perforate the aneurysm's fundus, remove the coils, and, fin ally, to clip the slack neck of the aneurysm. An attempt to precisely prepare and clip the aneurysmal neck without removing the coils could result in the rupture of the aneurysm's neck.