[Mechanically detachable coils in the treatment of posterior circulation aneurysms: a comparison with surgical repair].
OBJECTIVE
To compare craniotomy and clip application with endovascular coiling in patients with posterior circulation aneurysms.


METHODS
Among 676 consecutive patients with aneurysmal SAH who had been treated with either clipping or coiling, a group of 46 patients with aneurysms in the posterior circulation (32 treated surgically and 14 endovascularly) were selected for further investigation. Patient and aneurysm characteristics, procedural complications, and clinical and radiological results were compared retrospectively. The odds ratio for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for preoperative clinical condition parameters was assessed by logistic regression analysis. The group was not randomized.


RESULTS
In the endovascular group 6 patients (42.9%) had a poor outcome vs. 8 (25%) in the surgical group; the adjusted odds ratio for poor outcome after coiling vs. clipping was 3.21 (p = NS). The observed difference in outcome was consequent on higher incidence of severe neurological deficit (GOS 3) after embolisation, compared with clip application (26% and 9.4% of patients respectively); mortality was comparable in both groups (14.3% vs. 15.6%). Optimal or suboptimal aneurysm occlusion immediately after coiling was achieved in 12 patients (85.7%). Clipping was successful in 31 patients (96.9%).


CONCLUSIONS
There was no statistically significant difference in outcome between the two treatment groups. However, patients were less likely to be dependent when treated by craniotomy and clip application, compared with endovascular MDS embolisation.
Czepko
Ryszard
R
Klinika Neurochirurgii Instytutu Neurologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. rczepko@poczta.onet.pl
Libionka
Witold
W
Turski
Tadeusz
T
Uhl
Henryka
H
Pietraszko
Wojciech
W
D003399:Craniotomy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome