Interdisciplinary Neurosurgery (Sep 2020)

Surgical clipping compared to endovascular coiling of ruptured coil able middle cerebral aneurysms: A single-center experience

  • Mohammad Ghorbani,
  • Christoph J. Griessenauer,
  • Christoph Wipplinger,
  • Mohsen Nouri,
  • Sina Asaadi,
  • Ebrahim Hejazian,
  • Reza Mollahoseini,
  • Abolghasem Mortazavi

Journal volume & issue
Vol. 21
p. 100708

Abstract

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Objective: The middle cerebral artery (MCA) is the third most common site for ruptured intracranial aneurysms. Aneurysms in this location are known to be challenging to treat endovascularly and are commonly treated with microsurgery. Although advances in endovascular treatment options for cerebral aneurysms have markedly reduced the need for surgery in recent years and decades, there is no compelling scientific evidence that endovascular treatments are superior to surgical treatment. The present study aimed to determine the appropriate treatment modality in ruptured MCA aneurysms. Methods: We retrospectively evaluated and compared the treatment outcomes of 80 patients with ruptured MCA aneurysms who underwent either endovascular or microsurgical treatment in our center between 2011 and 2016. Post-treatment clinical and radiological outcomes were assessed in all patients. Furthermore, we compared intraoperative complications and the need for re-treatments between the two groups. Results: According to our findings, complete aneurysm occlusion was achieved in 90.5% and 89.2% of the patients in the clipping and coil group, respectively (p = 0.850). Moreover, 14.3% of the patients in the clipping group and 15.8% of the subjects in the coil group developed intraoperative complications (p = 0.851), including 3 cases of intraoperative hemorrhage and 3 cases of ischemia in the clipping group as well as 2 cases of thromboembolism and 4 cases of vasospasm during endovascular treatment in the coil group. There was an improvement in the modified Rankin score (mRS) at six months, with no significant difference between the two groups (p = 0.916). Conclusion: The results of coiling only with coil able MCA aneurysms were comparable to the results of clipping with difficult cases. Sufficient follow-up study of recurrence and retreatment are needed to determine the indication for coiling for ruptured MCA aneurysm.

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