Document Detail


Endovascular coiling compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: an update.
MedLine Citation:
PMID:  12378989     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: In 1999 we reported that 94% of unruptured middle cerebral artery (MCA) aneurysms managed prospectively between 1993 and 1997, according to a protocol favoring endovascular coiling, were best treated by surgical clipping. The goal of the current study was to delineate the most appropriate treatment option for unruptured MCA aneurysms today, considering the technical advances in imaging and in endovascular treatment. METHODS: 35 consecutive patients harboring 40 unruptured MCA aneurysms were treated between 1997 and December 2000. Patients with unruptured cerebral aneurysms are managed prospectively according to the same protocol as reported previously [1]: the primary treatment recommendation is endovascular packing with Guglielmi detachable coils (GDCs). Surgical clipping is recommended after failed attempt at coil placement or in the presence of angioanatomical features that contraindicate that type of endovascular therapy. RESULTS: One unruptured MCA aneurysm was treated by endovascular embolization, 37 unruptured MCA aneurysms were clipped, whereas 2 unruptured MCA aneurysms were trapped with simultaneous extracranial-intracranial revascularization. Postoperative angiography revealed complete exclusion of all aneurysms. Preservation of vascular permeability was demonstrated in all clip-reconstructed aneurysms, despite arterial branches frequently originating from the aneurysmal base. Cerebral revascularization of the distal MCA was successful in the 2 patients with giant aneurysms. None of the patients presented permanent disabling complications from the treatment of the unruptured MCA aneurysm. CONCLUSION: Despite major technical advances in imaging and in endovascular treatment of cerebral aneurysms, surgical clipping still is the most efficient treatment for unruptured MCA aneurysms at the beginning of the new millennium.
Authors:
L Regli; A R Dehdashti; A Uske; N de Tribolet
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  82     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2002  
Date Detail:
Created Date:  2002-10-15     Completed Date:  2003-04-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  41-6     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery and Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cerebral Angiography
Cerebral Revascularization
Combined Modality Therapy
Craniotomy*
Embolization, Therapeutic*
Female
Humans
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Intracranial Aneurysm / radiography,  surgery*
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Postoperative Complications / radiography
Retrospective Studies
Surgical Instruments
Tomography, X-Ray Computed

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


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