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Abstract - Original Article

J Cerebrovasc Endovasc Neurosurg. 2020 22(3): 165-175
The Journal of Cerebrovascular and Endovascular Neurosurgery
Microsurgical treatment for the recurrent cerebral aneurysm initially treated using coil embolization
Juwhan Lee1, Sung-Tae Kim1, Yong Woo Shim1, Jin Wook Back2, Jung Hae Ko3, Won Hee Lee1, Sung Hwa Paeng1, Se Young Pyo1, Young Jin Heo2, Hae Woong Jeong2, Young Gyun Jeong1
Departments of 1Neurosurgery and 2Radiology, Busan Paik Hospital, 3Department of Endocrinology, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea

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.
Key words : Intracranial aneurysm, Microsurgery, Recurrence, Retreatment

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