Publication:
Surgical Technology International XVI - Neurosurgery
Article title:
Cerebral Aneurysms: Conventional Microsurgical Technique and
Endovascular Method
Author(s)
Yasuhiko Kaku, M.D.
Professor and Chairman
Hirotaka Watarai, M.D.
Chief Resident
Jouji Kokuzawa, M.D.
Assistant Professor
Toshiki Tanaka, M.D.
Assistant Professor
Takashi Andoh, M.D.
Professor and Dean
Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan
Abstract
Recent advances in neurosurgery and interventional neuroradiology have brought us a new aspect in the treatment of cerebral aneurysms. The present series provides a balanced overview of the treatment of aneurysms in surgical clipping and coil embolization. Between January 2004 and March 2006, a total of 119 consecutive patients with cerebral aneurysms underwent endovascular embolization or surgical clipping. Of these, 79 patients suffered an aneurysmal subarachnoid hemorrhage (SAH), whereas the remaining 40 patients had nonruptured cerebral aneurysms. Of the 32 surgically treated patients, 25 (78.1%) achieved a favorable outcome. Of the 47 patients who underwent endovascular embolization, 38 (80.9%) achieved a favorable outcome. No significant difference was observed regarding the proportion of favorable outcomes between the two treatment modalities. Four patients (5.5%) who underwent endovascular embolization required re-treatments but no re-treatments were needed in the surgically treated patients. Of the 40 cases with nonruptured aneurysms, 12 (30%) were treated using surgical clipping, whereas 28 (70%) underwent endovascular embolization. The complication rates of the two treatment modalities demonstrated no significant difference. A combined microsurgical-endovascular team approach is thus considered to provide the most effective means to achieve favorable outcomes for patients with cerebral aneurysms. A case-by-case evaluation based on the individual characteristics of each aneurysm is therefore considered to be essential.