Endovascular surgery for very small ruptured intracranial aneurysms

Technical note

Restricted access

✓Application of endovascular surgery for very small aneurysms is controversial because of technical difficulties and high complication rates. The aim in the present study was to assess treatment results in a series of such lesions at one institution.

Since 1997, endovascular surgery has been advocated for very small ruptured aneurysms (<3 mm in maximum diameter) that fulfill the criterion of a fundus/neck ratio greater than 1.5. Twenty-one patients were treated, for whom the World Federation of Neurosurgical Societies classification before treatment was Grade I in 10, Grade II in two, Grade III in two, Grade IV in five, and Grade V in two. The aneurysm location was the internal carotid artery in four, the anterior communicating artery in 11, the middle cerebral artery in one, and the vertebrobasilar system in five. In all patients, endovascular surgery was performed using Guglielmi detachable coils after induction of general anesthesia. Initially, the presumed volume of the lesions was calculated for each aneurysm. Thereafter, the appropriate coil length was decided according to the volume embolization ratio, as 30 to 40%. In all attempts to obliterate aneurysms a single coil was used.

All aneurysms were completely obliterated as confirmed by postembolization angiography, without procedure-related complications. During the follow-up period only one patient needed additional coil embolization for a growing aneurysm. Final outcomes were good recovery in 15 patients, moderate disability in five, and severe disability in one.

Appropriate selection of patients and coils, and use of sophisticated techniques allow a good outcome for patients with very small aneurysms.

Abbreviations used in this paper:ACoA = anterior communicating artery; CT = computed tomography; GDC = Guglielmi detachable coil; ICA = internal carotid artery; MCA = middle cerebral artery; MR = magnetic resonance; PICA = posterior inferior cerebellar artery; SAH = subarachnoid hemorrhage; VA = vertebral artery; VER = volume embolization ratio; WFNS = World Federation of Neurosurgical Societies; 3D = three-dimensional.
Article Information

Contributor Notes

Address reprint requests to: Sachio Suzuki, M.D., Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kita-sato, Sagamihara, Kanagawa 228-8555, Japan. email: ssachio@med.kitasato-u.ac.jp.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Asakura FTenjin HSugawa NKimura SOki F: Evaluation of intra-aneurysmal blood flow by digital subtraction angiography: blood flow change after coil embolization. Surg Neurol 59:3103192003

    • Search Google Scholar
    • Export Citation
  • 2

    Boulin APierot L: Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium-enhanced 3D time-of-flight MR angiography and digital subtraction angiography. Radiology 219:1081132001

    • Search Google Scholar
    • Export Citation
  • 3

    Cognard CWeill ACastaings LRey AMoret J: Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:4995101998

    • Search Google Scholar
    • Export Citation
  • 4

    Moret JPierot LBoulin ACastaings LRey A: Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology 38:8008051996

    • Search Google Scholar
    • Export Citation
  • 5

    Pierot LBoulin ACastaings LRey AMoret J: Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery 38:9489541996

    • Search Google Scholar
    • Export Citation
  • 6

    Piotin MMounayer CSpelle LWilliams MTMoret J: Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol 25:3143182004

    • Search Google Scholar
    • Export Citation
  • 7

    Sluzewski MBosch JAvan Rooij WJNijssen PCGWijnalda D: Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg 94:2382402001

    • Search Google Scholar
    • Export Citation
  • 8

    Viñuela FDuckwiler GMawad M: Guglielmi detachable coil embolization of acute intracranial aneurysms: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:4754821997

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 150 149 15
Full Text Views 148 66 0
PDF Downloads 103 48 0
EPUB Downloads 0 0 0
PubMed
Google Scholar