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Microsurgical treatment for the recurrent cerebral aneurysm initially treated using coil embolization

대한뇌혈관외과학회지 2020년 22권 3호 p.165 ~ 175
이주환, 김성태, 심용우, 백진욱, 고정해, 이원희, 팽성화, 표세영, 허영진, 정해웅, 정영균,
소속 상세정보
이주환 ( Lee Ju-Whan ) - Inje university College of Medicine Busan Paik Hospital Department of Neurosurgery
김성태 ( Kim Sung-Tae ) - Inje university College of Medicine Busan Paik Hospital Department of Neurosurgery
심용우 ( Shim Yong-Woo ) - Inje university College of Medicine Busan Paik Hospital Department of Neurosurgery
백진욱 ( Back Jin-Wook ) - Inje University College of Medicine Busan Paik Hospital Department of Radiology
고정해 ( Ko Jung-Hae ) - Inje University College of Medicine Haeundae Paik Hospital Department of Internal Medicine
이원희 ( Lee Won-Hee ) - Inje university College of Medicine Busan Paik Hospital Department of Neurosurgery
팽성화 ( Paeng Sung-Hwa ) - Inje university College of Medicine Busan Paik Hospital Department of Neurosurgery
표세영 ( Pyo Se-Young ) - Inje university College of Medicine Busan Paik Hospital Department of Neurosurgery
허영진 ( Heo Young-Jin ) - Inje University College of Medicine Busan Paik Hospital Department of Radiology
정해웅 ( Jeong Hae-Woong ) - Inje University College of Medicine Busan Paik Hospital Department of Radiology
정영균 ( Jeong Young-Gyun ) - Inje university College of Medicine Busan Paik Hospital Department of Neurosurgery

Abstract


Objective: Microsurgical treatment could be a good alternative for the treatment of recurrent cerebral aneurysm after coil embolization. The purpose of this study was to present our experience of microsurgical treatment for recurrent cerebral aneurysm previously treated using coil embolization.

Methods: From June 2012 to May 2019, 34 patients consecutively received microsurgical treatment for a recurrent cerebral aneurysm previously treated using coil embolization after it ruptured.

Results: Of the 34 patients with aneurysm, 33 had the aneurysm located in the anterior circulation. The most common location was the anterior communicating artery (13 cases). Immediate radiologic outcome at coil embolization was completed (n=6), residual neck (n=26), and residual sac (n=2). The reason for microsurgical treatment included rebleeding (n=12), persistent residual sac (n=1), and recurrence on follow-up study (n=21). Rebleeding occurred within 10 days after coil embolization in 10 cases, and the other 2 were due to regrowth. In the 20 recurred and saccular aneurysms, coil compaction was present in 11 aneurysms and regrowth in 9 aneurysms. Simple neck clipping (n=29) and clipping with coil mass extraction (n=3) was possible in the saccular aneurysms. The blood blister like aneurysm (n=2) were treated using bypass and endovascular internal carotid artery trapping. In the follow-up study group after microsurgical treatment there were no severe complications due to the treatment. Age, cause of retreatment, and modified Rankin Scale before microsurgery were associated with good outcome (p<0.001).

Conclusions: Microsurgical treatment may be a viable and effective option for treating recurrent aneurysms previously treated by endovascular techniques.

키워드

Intracranial aneurysm; Microsurgery; Recurrence; Retreatment

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