Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy

Y. Jonathan Zhang, Daniel L. Barrow, C. Michael Cawley, Jacques E. Dion, Robert A. Solomon, Brian L. Hoh, Christopher S. Ogilvy, H. Hunt Batjer, Louis J. Kim, Robert F. Spetzler

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

OBJECTIVE: With the increased use of endovascular therapy, an increasing number of patients with incompletely treated intracranial aneurysms are presenting for further surgical management. This study reviews our experiences with such patients. METHODS: During a 7-year period, 38 patients with 40 intracranial aneurysms who were initially treated with endovascular therapy underwent surgical obliteration of refractory or recurrent lesions. All patients were recorded in a prospective registry, and their clinical data and imaging studies were analyzed retrospectively. RESULTS: Twenty-six anterior and 14 posterior circulation aneurysms were treated. Four aneurysms were on the cavernous internal carotid artery, 13 were on the distal internal carotid artery, 6 were on the anterior communicating artery complex, 2 were on the middle cerebral artery, 3 were on the posteroinferior cerebellar artery, 1 was at the vertebrobasilar junction, 3 were on the superior cerebellar artery, 4 were at the basilar apex, 2 were on the posterior cerebral artery, and 1 was on the distal vertebral artery. Two pseudoaneurysms - one on the petrocavernous segment of the internal carotid artery and one on the distal VA - also were treated. The median time until recurrence was 6 months. Thirty-one aneurysms were clip-ligated, and six were treated with trapping. Three extracranial-intracranial bypasses were performed. One aneurysm was treated with muslin wrapping. Two aneurysms required the use of surgical approaches that involved hypothermic circulatory arrest. Nine aneurysms required coil mass extraction and/or complex vascular reconstruction to complete lesion obliteration. All aneurysms except the single wrapped aneurysm were successfully excluded from the intracranial circulation. Two deaths occurred as a result of the operative procedures, and another patient died as a result of subarachnoid hemorrhage-induced massive myocardial infarction. Ultimately, 86.8% of patients achieved an excellent or good recovery. CONCLUSION: With endovascular therapy assuming an increasing role in the treatment of patients with intracranial aneurysms, more lesions that are refractory to initial treatment will require surgical management. Our experience indicates that good results are attainable, although technical challenges are frequently encountered.

Original languageEnglish (US)
Pages (from-to)283-295
Number of pages13
JournalNeurosurgery
Volume52
Issue number2
StatePublished - Feb 1 2003

Fingerprint

Intracranial Aneurysm
Aneurysm
Internal Carotid Artery
Arteries
Therapeutics
Posterior Cerebral Artery
Vertebral Artery
False Aneurysm
Operative Surgical Procedures
Middle Cerebral Artery
Subarachnoid Hemorrhage
Surgical Instruments
Blood Vessels
Registries
Myocardial Infarction
Recurrence

Keywords

  • Complications
  • Endovascular therapy
  • Intracranial aneurysm
  • Surgery postembolization

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Zhang, Y. J., Barrow, D. L., Cawley, C. M., Dion, J. E., Solomon, R. A., Hoh, B. L., ... Spetzler, R. F. (2003). Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. Neurosurgery, 52(2), 283-295.

Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. / Zhang, Y. Jonathan; Barrow, Daniel L.; Cawley, C. Michael; Dion, Jacques E.; Solomon, Robert A.; Hoh, Brian L.; Ogilvy, Christopher S.; Batjer, H. Hunt; Kim, Louis J.; Spetzler, Robert F.

In: Neurosurgery, Vol. 52, No. 2, 01.02.2003, p. 283-295.

Research output: Contribution to journalArticle

Zhang, YJ, Barrow, DL, Cawley, CM, Dion, JE, Solomon, RA, Hoh, BL, Ogilvy, CS, Batjer, HH, Kim, LJ & Spetzler, RF 2003, 'Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy', Neurosurgery, vol. 52, no. 2, pp. 283-295.
Zhang YJ, Barrow DL, Cawley CM, Dion JE, Solomon RA, Hoh BL et al. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. Neurosurgery. 2003 Feb 1;52(2):283-295.
Zhang, Y. Jonathan ; Barrow, Daniel L. ; Cawley, C. Michael ; Dion, Jacques E. ; Solomon, Robert A. ; Hoh, Brian L. ; Ogilvy, Christopher S. ; Batjer, H. Hunt ; Kim, Louis J. ; Spetzler, Robert F. / Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. In: Neurosurgery. 2003 ; Vol. 52, No. 2. pp. 283-295.
@article{5d077043f9d4404085c8e1dc1ed239a0,
title = "Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy",
abstract = "OBJECTIVE: With the increased use of endovascular therapy, an increasing number of patients with incompletely treated intracranial aneurysms are presenting for further surgical management. This study reviews our experiences with such patients. METHODS: During a 7-year period, 38 patients with 40 intracranial aneurysms who were initially treated with endovascular therapy underwent surgical obliteration of refractory or recurrent lesions. All patients were recorded in a prospective registry, and their clinical data and imaging studies were analyzed retrospectively. RESULTS: Twenty-six anterior and 14 posterior circulation aneurysms were treated. Four aneurysms were on the cavernous internal carotid artery, 13 were on the distal internal carotid artery, 6 were on the anterior communicating artery complex, 2 were on the middle cerebral artery, 3 were on the posteroinferior cerebellar artery, 1 was at the vertebrobasilar junction, 3 were on the superior cerebellar artery, 4 were at the basilar apex, 2 were on the posterior cerebral artery, and 1 was on the distal vertebral artery. Two pseudoaneurysms - one on the petrocavernous segment of the internal carotid artery and one on the distal VA - also were treated. The median time until recurrence was 6 months. Thirty-one aneurysms were clip-ligated, and six were treated with trapping. Three extracranial-intracranial bypasses were performed. One aneurysm was treated with muslin wrapping. Two aneurysms required the use of surgical approaches that involved hypothermic circulatory arrest. Nine aneurysms required coil mass extraction and/or complex vascular reconstruction to complete lesion obliteration. All aneurysms except the single wrapped aneurysm were successfully excluded from the intracranial circulation. Two deaths occurred as a result of the operative procedures, and another patient died as a result of subarachnoid hemorrhage-induced massive myocardial infarction. Ultimately, 86.8{\%} of patients achieved an excellent or good recovery. CONCLUSION: With endovascular therapy assuming an increasing role in the treatment of patients with intracranial aneurysms, more lesions that are refractory to initial treatment will require surgical management. Our experience indicates that good results are attainable, although technical challenges are frequently encountered.",
keywords = "Complications, Endovascular therapy, Intracranial aneurysm, Surgery postembolization",
author = "Zhang, {Y. Jonathan} and Barrow, {Daniel L.} and Cawley, {C. Michael} and Dion, {Jacques E.} and Solomon, {Robert A.} and Hoh, {Brian L.} and Ogilvy, {Christopher S.} and Batjer, {H. Hunt} and Kim, {Louis J.} and Spetzler, {Robert F.}",
year = "2003",
month = "2",
day = "1",
language = "English (US)",
volume = "52",
pages = "283--295",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy

AU - Zhang, Y. Jonathan

AU - Barrow, Daniel L.

AU - Cawley, C. Michael

AU - Dion, Jacques E.

AU - Solomon, Robert A.

AU - Hoh, Brian L.

AU - Ogilvy, Christopher S.

AU - Batjer, H. Hunt

AU - Kim, Louis J.

AU - Spetzler, Robert F.

PY - 2003/2/1

Y1 - 2003/2/1

N2 - OBJECTIVE: With the increased use of endovascular therapy, an increasing number of patients with incompletely treated intracranial aneurysms are presenting for further surgical management. This study reviews our experiences with such patients. METHODS: During a 7-year period, 38 patients with 40 intracranial aneurysms who were initially treated with endovascular therapy underwent surgical obliteration of refractory or recurrent lesions. All patients were recorded in a prospective registry, and their clinical data and imaging studies were analyzed retrospectively. RESULTS: Twenty-six anterior and 14 posterior circulation aneurysms were treated. Four aneurysms were on the cavernous internal carotid artery, 13 were on the distal internal carotid artery, 6 were on the anterior communicating artery complex, 2 were on the middle cerebral artery, 3 were on the posteroinferior cerebellar artery, 1 was at the vertebrobasilar junction, 3 were on the superior cerebellar artery, 4 were at the basilar apex, 2 were on the posterior cerebral artery, and 1 was on the distal vertebral artery. Two pseudoaneurysms - one on the petrocavernous segment of the internal carotid artery and one on the distal VA - also were treated. The median time until recurrence was 6 months. Thirty-one aneurysms were clip-ligated, and six were treated with trapping. Three extracranial-intracranial bypasses were performed. One aneurysm was treated with muslin wrapping. Two aneurysms required the use of surgical approaches that involved hypothermic circulatory arrest. Nine aneurysms required coil mass extraction and/or complex vascular reconstruction to complete lesion obliteration. All aneurysms except the single wrapped aneurysm were successfully excluded from the intracranial circulation. Two deaths occurred as a result of the operative procedures, and another patient died as a result of subarachnoid hemorrhage-induced massive myocardial infarction. Ultimately, 86.8% of patients achieved an excellent or good recovery. CONCLUSION: With endovascular therapy assuming an increasing role in the treatment of patients with intracranial aneurysms, more lesions that are refractory to initial treatment will require surgical management. Our experience indicates that good results are attainable, although technical challenges are frequently encountered.

AB - OBJECTIVE: With the increased use of endovascular therapy, an increasing number of patients with incompletely treated intracranial aneurysms are presenting for further surgical management. This study reviews our experiences with such patients. METHODS: During a 7-year period, 38 patients with 40 intracranial aneurysms who were initially treated with endovascular therapy underwent surgical obliteration of refractory or recurrent lesions. All patients were recorded in a prospective registry, and their clinical data and imaging studies were analyzed retrospectively. RESULTS: Twenty-six anterior and 14 posterior circulation aneurysms were treated. Four aneurysms were on the cavernous internal carotid artery, 13 were on the distal internal carotid artery, 6 were on the anterior communicating artery complex, 2 were on the middle cerebral artery, 3 were on the posteroinferior cerebellar artery, 1 was at the vertebrobasilar junction, 3 were on the superior cerebellar artery, 4 were at the basilar apex, 2 were on the posterior cerebral artery, and 1 was on the distal vertebral artery. Two pseudoaneurysms - one on the petrocavernous segment of the internal carotid artery and one on the distal VA - also were treated. The median time until recurrence was 6 months. Thirty-one aneurysms were clip-ligated, and six were treated with trapping. Three extracranial-intracranial bypasses were performed. One aneurysm was treated with muslin wrapping. Two aneurysms required the use of surgical approaches that involved hypothermic circulatory arrest. Nine aneurysms required coil mass extraction and/or complex vascular reconstruction to complete lesion obliteration. All aneurysms except the single wrapped aneurysm were successfully excluded from the intracranial circulation. Two deaths occurred as a result of the operative procedures, and another patient died as a result of subarachnoid hemorrhage-induced massive myocardial infarction. Ultimately, 86.8% of patients achieved an excellent or good recovery. CONCLUSION: With endovascular therapy assuming an increasing role in the treatment of patients with intracranial aneurysms, more lesions that are refractory to initial treatment will require surgical management. Our experience indicates that good results are attainable, although technical challenges are frequently encountered.

KW - Complications

KW - Endovascular therapy

KW - Intracranial aneurysm

KW - Surgery postembolization

UR - http://www.scopus.com/inward/record.url?scp=0037309844&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037309844&partnerID=8YFLogxK

M3 - Article

C2 - 12535356

AN - SCOPUS:0037309844

VL - 52

SP - 283

EP - 295

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 2

ER -