title: Management of complex, surgically intractable intracranial aneurysms: the option for intentional reconstruction of aneurysm neck followed by endovascular coiling.
abstract: BACKGROUND
  A limited series of patients with aneurysm were reviewed retrospectively to analyze strategies for integrating microsurgical and endovascular techniques in the management of complex, surgically intractable aneurysms.
  
  
  METHODS
  Four patients were managed in Fujita Health University with a multimodality approach: intentional reconstruction of the aneurysm neck followed by endovascular coiling.
  
  
  RESULTS
  A total of 5 aneurysms were treated, of which 3 were large or giant in size, and 3 were fusiform or multilobulated. Complete angiographic obliteration was confirmed in 4 aneurysms (80%). All patients had a good outcome (Glasgow Outcome Scale score 5; mean follow-up, 64 months).
  
  
  CONCLUSIONS
  As for complex, surgically intractable aneurysms, the intentional reconstruction of the aneurysm neck followed by endovascular coiling should be considered more often.
authors.affiliation: Department of Neurosurgery, Fujita Health University, Toyoake, Japan. neuro_clk@hotmail.com
authors.forename: Lukui
authors.initials: L
authors.lastname: Chen
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Sano
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoneda
authors.forename: Motoharu
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Akiyo
authors.initials: A
authors.lastname: Sadato
authors.forename: Keiko
authors.initials: K
authors.lastname: Irie
authors.forename: Makoto
authors.initials: M
authors.lastname: Negoro
authors.forename: Kostadin L
authors.initials: KL
authors.lastname: Karagiozov
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kanno
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000295:instrumentation; D002560:Cerebrovascular Circulation; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013525:Surgical Instruments; D016896:Treatment Outcome; D014654:Vascular Patency