Surgery following endovascular coiling of intracranial aneurysms

BACKGROUND Surgery for intracranial aneurysms that have been treated by endovascular c oiling is a new challenge for neurosurgeons and the need for it will undoub tedly continue to increase. The indications for, timing, and technique of s urgery in our experience are described. METHODS We have reviewed our experience with 11 patients who underwent surgery foll owing endovascular coiling with Guglielmi detachable coils (GDCs) of an ane urysm. We analyzed the indications for surgery, surgical techniques used, a nd patient outcome. RESULTS There were nine female and two male patients. The mean age was 49 years (ra nge 13 to 67 years). The intervals between coiling and surgery were 1, 2, 3 , 4, 7, 7, 10, and 14 days, 6 weeks, 2, 18, and 25 months. The indications for surgery were partial treatment (3), growth of residual neck (2), persis tent mass effect of a giant aneurysm (2), mass effect from the coil ball (2 ), coil migration (2), and coil protrusion with embolic event (1). The coil s were removed at the time of surgery from 9 of 11 aneurysms before clippin g. In two cases it was possible to place a clip across the neck of the aneu rysm without removing the coils, as the coils no longer occupied the neck. There were two permanent deficits directly related to the endovascular proc edures. Two other patients who presented with subarachnoid hemorrhage had r esidual neurological deficits post surgery and one patient with a giant ane urysm had persistent visual loss. CONCLUSION Surgery remains a viable option at any time for treating aneurysms that hav e been previously treated by GDC placement. The operative approach is deter mined by the need for coil removal and the duration since coiling. (C) 2000 by Elsevier Science Inc.