Document Detail


Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series.
MedLine Citation:
PMID:  10350247     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The goal of this study was to delineate the angioanatomical features that determine whether a patient with an unruptured middle cerebral artery (MCA) aneurysm is treated using endovascular coil placement or surgical clipping. METHODS: Thirty consecutive patients harboring 34 unruptured MCA aneurysms were evaluated. Patients with unruptured aneurysms are managed prospectively according to the following protocol: the primary treatment recommendation is endovascular packing with Guglielmi detachable coils (GDCs). Surgical clipping is recommended after failed attempts at coil placement or in the presence of angioanatomical features that contraindicate that type of endovascular therapy. Of 34 unruptured MCA aneurysms, two (6%) were successfully embolized and 32 (94%) were clipped. Of these 32 surgically treated aneurysms, in 11 (34%) an attempt at GDC embolization had failed, whereas in 21 (66%) primary clipping was performed because of unfavorable angioanatomy. Of the 13 aneurysms treated endovascularly, two (15%) were successfully excluded, whereas GDC treatment failed in 11 (85%). An unfavorable dome/neck ratio (< 2) and an arterial branch originating at the aneurysm base were the reasons for embolization failure. CONCLUSIONS: Careful evaluation of the angioanatomy of unruptured aneurysms allows selection of the most appropriate treatment. However, for unruptured MCA aneurysms, surgical clipping appears to be the most efficient treatment option. Series of unruptured aneurysms are ideal for comparing treatment results.
Authors:
L Regli; A Uske; N de Tribolet
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  90     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-06-14     Completed Date:  1999-06-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1025-30     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Luca.Regli@chuv.hospvd.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Aneurysm, Ruptured / therapy
Angiography, Digital Subtraction
Cerebral Angiography
Cerebral Arteries / surgery
Embolization, Therapeutic / instrumentation*
Female
Humans
Intracranial Aneurysm / radiography,  surgery,  therapy*
Male
Middle Aged
Postoperative Complications
Treatment Failure
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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