Abstract
Object
Coil extraction during microsurgery for recanalized intracranial aneurysms can be associated with high morbidity. We evaluated our preliminary experience using the clip-coil ratio to predict the need for coil extraction.
Methods
A multi-institutional retrospective review of previously coiled aneurysms that were clipped for recurrence between 2005 and 2009 was performed. The maximal height and the widths of the recanalization were measured. The largest of these dimensions was divided by the other. We defined this as the clip-coil ratio, which is a modification of the aspect ratio.
Results
Thirteen patients were included in this study. The mean age of the patients was 53 years (range 41–68 years). The aneurysm locations were anterior communicating artery (n = 5), pericallosal artery (n = 2), ophthalmic artery (n = 1), and posterior communicating artery (n = 5). A clip-coil ratio ≥1.3 allowed for microsurgical clipping without coil extraction. The mean ratio in these patients was 1.6. Coil extraction was necessary in two patients with a clip-coil ratio <1.3.
Conclusion
In reviewing our preliminary experience, we observed that coil extraction during microsurgery was not necessary when the clip coil ratio was ≥1.3. The ratio may serve as an indirect indicator of the amount of aneurysm tissue that can be incorporated within a clip; however, given the small patient population, further studies are needed to validate this concept.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Boet R, Poon WS, Yu SC (2001) The management of residual and recurrent intracranial aneurysms after previous endovascular or surgical treatment—a report of eighteen cases. Acta Neurochir (Wien) 143:1093–1101
Byrne JV, Sohn MJ, Molyneux AJ, Chir B (1999) Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg 90:656–663
Civit T, Auque J, Marchal JC, Bracard S, Picard L, Hepner H (1996) Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery 38:955–960; discussion 960–951
Conrad MD, Pelissou-Guyotat I, Morel C, Madarassy G, Schonauer C, Deruty R (2002) Regrowth of residual ruptured aneurysms treated by Guglielmi's Detachable Coils which demanded further treatment by surgical clipping: report of 7 cases and review of the literature. Acta Neurochir (Wien) 144:419–426
Deinsberger W, Mewes H, Traupe H, Boeker DK (2003) Surgical management of previously coiled intracranial aneurysms. Br J Neurosurg 17:149–154
Feuerberg I, Lindquist C, Lindqvist M, Steiner L (1987) Natural history of postoperative aneurysm rests. J Neurosurg 66:30–34
Gurian JH, Martin NA, King WA, Duckwiler GR, Guglielmi G, Vinuela F (1995) Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 83:843–853
Horowitz M, Purdy P, Kopitnik T, Dutton K, Samson D (1999) Aneurysm retreatment after Guglielmi detachable coil and nondetachable coil embolization: report of nine cases and review of the literature. Neurosurgery 44:712–719; discussion 719–720
Konig RW, Kretschmer T, Antoniadis G, Seitz K, Braun V, Richter HP, Perez de Laborda M, Scheller C, Borm W (2007) Neurosurgical management of previously coiled recurrent intracranial aneurysms. Zentralbl Neurochir 68:8–13
Ladouceur DL (1993) Transcranial clipping of recurrent cerebral aneurysms after endovascular treatment. Stroke 24:1087–1089
Lawton MT, Quinones-Hinojosa A, Sanai N, Malek JY, Dowd CF (2003) Combined microsurgical and endovascular management of complex intracranial aneurysms. Neurosurgery 52:263–274 discussion 274–265
Lin T, Fox AJ, Drake CG (1989) Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560
Mizoi K, Yoshimoto T, Takahashi A, Nagamine Y (1996) A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery 39:165–168; discussion 168–169
Nader-Sepahi A, Casimiro M, Sen J, Kitchen ND (2004) Is aspect ratio a reliable predictor of intracranial aneurysm rupture? Neurosurgery 54:1343–1347; discussion 1347–1348
Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403
Thornton J, Dovey Z, Alazzaz A, Misra M, Aletich VA, Debrun GM, Ausman JI, Charbel FT (2000) Surgery following endovascular coiling of intracranial aneurysms. Surg Neurol 54:352–360
Veznedaroglu E, Benitez RP, Rosenwasser RH (2008) Surgically treated aneurysms previously coiled: lessons learned. Neurosurgery 62:1516–1524
Zhang YJ, Barrow DL, Cawley CM, Dion JE (2003) Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. Neurosurgery 52:283–293; discussion 293–285
Acknowledgement
KRB thanks Murat Gunel, MD for his suggestions regarding the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bulsara, K.R., Hoh, B., Rosen, C. et al. Preliminary observation on predicting the need for coil extraction during microsurgery: the clip-coil ratio. Acta Neurochir 152, 431–434 (2010). https://doi.org/10.1007/s00701-009-0559-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-009-0559-z