Intentional partial coiling dome protection of complex ruptured cerebral aneurysms prevents acute rebleeding and produces favorable clinical outcomes

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• 作者：Ben Waldau (1)
  John F. Reavey-Cantwell (2)
  Matthew F. Lawson (1)
  Shady Jahshan (3)
  Elad I. Levy (3)
  Adnan H. Siddiqui (3)
  J. Mocco (1)
  Brian L. Hoh (1) (4)
  
• 关键词：Clipping ; Partial coiling ; Aneurysm ; Rebleeding ; Subarachnoid hemorrhage ; Dome protection
• 刊名：Acta Neurochirurgica
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：154
• 期：1
• 页码：27-31
• 全文大小：114KB
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• 作者单位：Ben Waldau (1)
  John F. Reavey-Cantwell (2)
  Matthew F. Lawson (1)
  Shady Jahshan (3)
  Elad I. Levy (3)
  Adnan H. Siddiqui (3)
  J. Mocco (1)
  Brian L. Hoh (1) (4)
  
  1. Department of Neurosurgery, University of Florida, Gainesville, FL, USA
  2. Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
  3. Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA
  4. Department of Neurological Surgery, University of Florida, P.O. Box 100265, Gainesville, FL, 32610, USA
  

文摘

Background The coiling of ruptured cerebral aneurysms protects against acute rebleeding; however, whether partially coiling a ruptured cerebral aneurysm protects against acute rebleeding has never been demonstrated. Objective This study was performed to test our hypothesis that intentional partial coiling of complex ruptured cerebral aneurysms, which are unfavorable for clipping and cannot be completely coiled primarily, prevents acute rebleeding to allow for clinical and neurological recovery until definitive treatment and produces favorable clinical outcomes. Methods Data were collected from the prospective databases of three centers. Only subarachnoid hemorrhage patients that were treated with a strategy of intentional partial coiling for dome protection were included. This did not include patients in whom the goal was complete coiling but only subtotal coil occlusion was achieved. Results Fifteen patients [aged 51?±-3?years; HH 3- (n--); Fisher 3- (n--)] were treated with intentional partial dome protection. Aneurysm size was 12.8?±-.4?mm; neck size 4.9?±-?mm; 12 anterior circulation. Four intentional partial coilings were performed with balloon assistance. Definitive treatment was performed 92?±-0?days later, with no case of rebleeding. Definitive treatment was clipping (n--), stent-coiling (n--), Onyx (n--), further coiling (n--). Clinical outcome was favorable in 13 cases (GOS 4-), fair in one (GOS 3), and death in one (GOS 1). Conclusions Judicious use of a treatment strategy of intentional partial dome protection for complex aneurysms that are not favorable for clipping and in which complete coiling primarily is not possible may prevent acute rebleeding and produce favorable clinical outcomes.