Combined endovascular and microsurgical treatment of multiple cerebral aneurysms

Abstract

Recent advances in interventional neuroradiology brought all multiple cerebral aneurysms (MCA) could be occluded using endovascular techniques. A multimodal approach (combined microsurgical and endovascular) should be considered as a possible treatment option for MCA to improve treatment outcomes by simplifying the technical complexity of endovascular occlusion and providing sustained long-term occlusion. Objective ‒ to analyze the results of combined microsurgical and endovascular treatment of MCA. Materials and methods. A retrospective analysis of the results of evaluation and surgical treatment of 172 patients with MCA in Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine from April 2016 to February 2022. In 7 (4.1 %) patients, combined endovascular and microsurgical treatment of MCA was done. Results. In 7 patients (4 women and 3 men, mean age ‒ 39.3 years), 19 aneurysms (size from 3 to 15 mm) were detected, of which 15 (78.9 %) were located in the anterior semicircle, 4 (21.1 % ) ‒ in the posterior. All aneurysms of the basilar circulation were excluded using endovascular approach. In 4 (57.1 %) patients, the aneurysms were ruptured. Ten (52.6 %) aneurysms were occluded endovascularly (6 with coil s only, 2 with balloon-assisted coiling, 1 with stent-assisted coiling, and 1 with flow-deverter stent), 9 (47.4 %) aneurysms were clipped. One (5.3 %) periprocedural complication after endovascular treatment was noted ‒ prolapse of the coil into the vessel. In 2 (22.2 %) cases, residual aneurysm was detected after clipping, which was occluded with coils. The rate of total aneurysm occlusion at discharge was 94.7 %. All patients were discharged from the hospital with favorable results (score ≤2 points on the modified Rankine scale). Stable effective occlusion after 3 months was noted in 17 (89.5 %) aneurysms, 2 (10.5 %) aneurysms were filled at the level of the neck. Conclusions. Combined endovascular and microsurgical treatment is a technically feasible treatment option for MCA and is considered in patients where the conventional approach with either method has failed or is associated with a high risk of complications. Our series has demonstrated the safety and efficacy of combined MCA treatment.

Keywords

• multiple cerebral aneurysms; endovascular treatment; microsurgical clipping; treatment results; combined treatment.