Patient outcome after endovascular treatment of intracranial aneurysms with reference to microsurgical clipping

Objectives - Endovascular treatment of intracranial aneurysms with Guglielm i detachable coils (GDC) has found growing acceptance worldwide, and partia lly replaced conventional microsurgery. In this study clinical and angiogra phical results of embolization are reviewed. In addition, long-term neurops ychological patient outcome with reference to surgery is assessed. Indicati ons for screening and follow-up of the patients as limitations and recent a chievements of aneurysm embolization are discussed. Material and methods - Angiographical and clinical follow-up of the first 44 patients with 48 GDC- coiled aneurysms are reviewed. Postprocedural clinical, emotional and socia l (CES) outcome on disability scale as scored from postal questionnaire dat a is presented and compared to 106 currently operated patients. Results - I n 75% of the embolized aneurysms successful occlusion was achieved, procedu ral mortality was 2.3% and morbidity 18.2%. Clinical status of all 15 patie nts with unruptured aneurysms preserved. Of the surviving 29 patients with ruptured aneurysms 12 improved and the rest preserved their clinical status . In 91% of the embolized patients and in 85% of the operated patients CES outcome was categorized as good or excellent. The difference was statistica lly nonsignificant. Conclusion - Embolization with GDC is a feasible, effec tive and safe mini-invasive method in small aneurysms with a small neck. Ho wever, intentional parent artery occlusion, novel endovascular techniques a nd embolic agents or supplementary surgery may be necessary in selected cas es. Neuropsychological long-term outcome of the patients treated for an int racranial aneurysm does not differ much betweeen GDC embolization and micro surgical clipping.