Combined management of intracranial aneurysms by surgical and endovasculartreatment. Modalities and results from a series of 395 cases

The selective occlusion of saccular intracranial aneurysms may be achieved by two techniques: microsurgical clipping and endovascular coiling. Each of them have particular indications which need to be defined. We report on a series in which both techniques were applied. From September 1992 to June 1996, 395 consecutive patients with small or la rge aneurysm were treated either by surgery (N = 102) or by endovascular co iling (N = 293). Coiling was chosen each time the shape of the aneurysm see med to be appropriate for this treatment: narrow neck and ratio neck diamet er by sac diameter less than one third. Satisfactory results with complete or subtotal obliteration and no recanali zation on the following controls at 1, 6, 12 and 36 months, were obtained i n 92% before retreatment and in 98.8% after retreatment. Unsatisfactory res ults were observed after surgery in 7 cases and in 25 cases after embolizat ion. After retreatment, it remains 3 post-surgical and 2 post-endovascular cases. In the overall series, good and excellent clinical outcome was noted in 90% for small aneurysms and in 86.5% for large ones; mortality was of 4.8%. In a series in which were applied both types of treatment, surgery in 25% a nd endovascular technique in 75%, good results in terms of aneurysm occlusi on and clinical results were achieved. These results are as good as the bes t series in which surgery was the only choice. Therefore with appropriate s election, endovascular treatment is a good alternative for treatment of the majority of saccular aneurysms.