title: Early and late microsurgical clipping for initially coiled intracranial aneurysms.
abstract: BACKGROUND
  An increasing number of patients with incompletely treated and recurrent intracranial aneurysms are presenting for further management. We review the patients who underwent microsurgical clipping of previously coiled intracranial aneurysms.
  
  
  METHODS
  From 2001 to 2008, we treated 623 aneurysms by endovascular treatment. Among them, 29 patients underwent microsurgical clipping. Nineteen patients (group A) underwent early surgical intervention due to incomplete coiling, a residual neck, coil protrusion, aneurysm rupture, or coil stretching. Ten patients (group B) underwent surgical clipping for recurrent aneurysm and an increased mass effect during the follow-up period. The radiographic images and clinical data were reviewed retrospectively to determine the treatment efficacy, the clinical outcomes, and the factors that are important to select the proper treatment modality.
  
  
  RESULTS
  There were 13 female and 16 male patients. The coils were removed in 6 of the 19 patients in group A and in 1 of the 10 patients in group B. Seventeen (89.5%) of the 19 patients in group A and all the patients (100%) in group B achieved good recovery (Glasgow Outcome Scale 5 and 4) during the clinical follow-up periods (mean 25.2 months).
  
  
  CONCLUSIONS
  Microsurgical clipping may be chosen as a safe and permanent treatment option for the previously coiled aneurysms with acceptable morbidity in properly selected cases.
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Republic of Korea.
authors.forename: Joonho
authors.initials: J
authors.lastname: Chung
authors.forename: Yong Cheol
authors.initials: YC
authors.lastname: Lim
authors.forename: Bum-soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Dongwoo
authors.initials: D
authors.lastname: Lee
authors.forename: Kwan-Sung
authors.initials: KS
authors.lastname: Lee
authors.forename: Yong Sam
authors.initials: YS
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Stroke. 2007 May;38(5):1538-44
references.pmid: 17395870
references.citation: Br J Neurosurg. 2006 Oct;20(5):306-11
references.pmid: 17129879
references.citation: Neurosurgery. 2004 Feb;54(2):300-3; discussion 303-5
references.pmid: 14744275
references.citation: Clin Neurol Neurosurg. 2007 Nov;109(9):744-52
references.pmid: 17706339
references.citation: AJNR Am J Neuroradiol. 1999 Mar;20(3):391-9
references.pmid: 10219403
references.citation: Radiology. 2004 Jun;231(3):653-8
references.pmid: 15118115
references.citation: Stroke. 2006 Jun;37(6):1437-42
references.pmid: 16627789
references.citation: Neurosurgery. 1999 Apr;44(4):712-9; discussion 719-20
references.pmid: 10201295
references.citation: Lancet Neurol. 2009 May;8(5):427-33
references.pmid: 19329361
references.citation: Neurosurgery. 2006 Feb;58(2):224-32; discussion 224-32
references.pmid: 16462475
references.citation: Surg Neurol. 2005 Feb;63(2):149-54; discussion 154-5
references.pmid: 15680657
references.citation: Surg Neurol. 2000 Nov;54(5):352-60
references.pmid: 11165609
references.citation: Neurosurgery. 2002 Feb;50(2):239-49; discussion 249-50
references.pmid: 11844258
references.citation: J Neurosurg. 2002 Oct;97(4):843-50
references.pmid: 12405372
references.citation: Stroke. 2003 Jun;34(6):1398-403
references.pmid: 12775880
references.citation: J Neurosurg. 1998 Dec;89(6):956-61
references.pmid: 9833822
references.citation: Stroke. 1993 Jul;24(7):1087-9
references.pmid: 8322385
references.citation: AJNR Am J Neuroradiol. 2005 Aug;26(7):1739-43
references.pmid: 16091523
references.citation: Neurosurgery. 2006 Jan;58(1):60-70; discussion 60-70
references.pmid: 16385330
references.citation: Neurosurgery. 2003 Feb;52(2):263-74; discussion 274-5
references.pmid: 12535354
references.citation: Lancet. 2005 Sep 3-9;366(9488):809-17
references.pmid: 16139655
references.citation: Neurosurgery. 2003 Feb;52(2):283-93; discussion 293-5
references.pmid: 12535356
references.citation: Acta Neurochir (Wien). 2009 Dec;151(12):1609-16
references.pmid: 19572101
references.citation: Acta Neurochir (Wien). 2002 May;144(5):419-26
references.pmid: 12111497
references.citation: Neurosurgery. 2008 Oct;63(4):684-91; discussion 691-2
references.pmid: 18981879
references.citation: Neurosurg Rev. 2003 Oct;26(4):269-74
references.pmid: 12802695
references.citation: Br J Neurosurg. 2003 Apr;17(2):149-54
references.pmid: 12820757
references.citation: Neurosurgery. 1996 May;38(5):955-60; discussion 960-1
references.pmid: 8727821
references.citation: J Neurosurg. 1995 Nov;83(5):843-53
references.pmid: 7472553