Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option

Object. The aim of this study was to evaluate prospectively the results of treating cerebral aneurysms with coil embolization (CE) or with surgical cl ipping when CE was considered the first option. Methods. Whenever an aneurysm was to be treated, CE was first considered by our neurovascular team. Surgical clipping was reserved for cases excluded from CE or cases in which CE failed. The study consisted of 103 consecutive patients with 132 aneurysms, of which 127 were treated. Coil embolization was performed using Guglielmi detachable coils, and surgery was performed u sing Zeppelin clips. Three groups were defined: Group A consisted of 64 ane urysms that were treated by CE (neck/sac ratio < 1:3); Group B, 63 aneurysm s that were surgically clipped: and Group C, 12 aneurysms that failed to be satisfactorily (greater than or equal to 95%) embolized and were subsequen tly clipped. The percentages of residual aneurysm were 31.2% in Group A, 1. 6% in Group B, and 0% in Group C. The percentages of patients with poor Gla sgow Outcome Scale (GOS) scores (GOS Scores 1-3) were 13.3% in Group A, 6.1 % in Group B, and 8.3% in Group C. The percentages of poor outcome (GOS Sco res 1-3) in patients with good clinical status before treatment were 10.7% in Group A, 0% in Group B, and 8.3% in Group C. Conclusions. Even with preselection, CE remains associated with a significa nt number of treatment failures and poor outcomes, even in patients with go od preoperative clinical status. Surgical clipping can offer better results than CE, even for more complex aneurysms of the anterior circulation, espe cially fur those involving the middle cerebral artery cases. However, becau se CE can be effective and causes less stress and invasiveness for the pati ent, it should be considered first in aneurysms strictly selected by a neur ovascular team.