Endovascular Treatment in Post - Surgical Cerebral Aneurysms

Objective : The authors present the result of endovascular treatment in cases of residual or recurrent cerebral aneurysms after surgery. Methods : 370 cases harboring 410 aneurysms underwent endovascular coil embolization over the past eight years. We selected 13 cases that underwent coil embolization in the post-surgical condition with residual or recurrent aneurysms. Radiologic and clinical data were reviewed to determine reasons of referral, outcomes, and technical problems of postsurgical endovascular treatment. Results : The mean interval from surgery to endovascular treatment was 23 months (range 0 day to 121 months). The reasons of postsurgical endovascular treatment were : 1) incomplete clipping (n=6); 2) failed clipping (n=3); and 3) rehemorrhage (n=4). Among the 4 cases of rehemorrhage, 3 cases presented with recurrent aneurysms after clipping; one case had undergone aneurysm wrapping. At time of endovascular treatment three patients were classified as HuntHess Grade 0, two Grade I, three Grade II, and five Grade III. In all 13 cases, treatments by endovascular coil embolization were successful, resulting in total or near total occlusion of aneurysms, with no procedure-related morbidity or mortality. Clinical outcome at time of the last clinical evaluation was; Glasgow Outcome Scale (GOS) 5 in ten patients, GOS 4 in one, and GOS 3 in one. Mean duration of follow-up was 17 months. No subarachnoid hemorrhage or aneurysm regrowth was noted during the follow-up period. Conclusion : Endovascular coil embolization is a good alternative treatment modality in cases of postoperative residual or recurrent aneurysms.