title: The maze-making and solving technique for coil embolization of large and giant aneurysms.
abstract: OBJECTIVE
  Despite major progress in treating aneurysms by coil embolization, the complete occlusion of aneurysms of >10 mm in diameter (large/giant aneurysms) remains challenging. We present a novel endovascular treatment method for large and giant cerebral aneurysms called the "maze-making and solving" technique and compare the short-term follow-up results of this technique with those of conventional coil embolization.
  
  
  METHODS
  Eight patients (65 ± 11.5 years of age, 7 women) with large/giant unruptured nonthrombosed cerebral aneurysm (mean largest aneurysm dimension, 19 ± 4.4 mm) were treated by the maze-making and solving technique, a combination of the double-catheter technique and various assisted techniques. The coil-packing attenuation, postoperative courses, and recurrence rate of this maze group were compared with 30 previous cases (conventional group, 65.4 ± 13.0 years of age; 22 women; mean largest aneurysm dimension, 13.4 ± 3.8 mm).
  
  
  RESULTS
  Four maze group cases were Raymond class 1; and 4 were class 2 as indicated by immediate postsurgical angiography. No perioperative deaths or major strokes occurred. Mean packing attenuation of the maze group was significantly higher than that of the conventional group (37.4 ± 5.9% versus 26.2 ± 5.6%). Follow-up angiography performed at 11.3 ± 5.4 months revealed no recurrence in the maze group compared with 39.2% in the conventional group.
  
  
  CONCLUSIONS
  The maze-making and solving technique achieves high coil-packing attenuation for efficient embolization of large and giant cerebral aneurysms with a low risk of recurrence.
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan. tsuyoshi@ya2.so-net.ne.jp.
authors.forename: T
authors.initials: T
authors.lastname: Ohta
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Nakahara
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Ishibashi
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Gomi
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miyata
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nishi
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Nagata
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome