脳動脈瘤治療における補助的血管内または外科治療の有用性(<特集>脳動脈瘤の複合手術)  [in Japanese] Analysing Cooperation of Surgical and Endovascular Treatment for Cerebral Aneurysms(<Topics> Multimodality Therapy for Cerebral Aneurysms)  [in Japanese]

Endovascular treatment has become a major treatment modality for cerebral aneurysms. However, some aneurysms are difficult to treat using a single modality. We analyzed combined endovascular and surgical treatments of aneurysms. From May 1997 to December 2005, there were 185 cases (198 aneurysms) of treated endovascular aneurysms, 86 of which were ruptured and 99 of which were unruptured. Supplemental combinations of both treatments were performed in 25 of the ruptured and 26 of unruptured cases. Supplemental treatments were classified into a combination of endovascular and clipping for multiple aneurysms (19 cases), surgical clipping for failed endovascular attempt (12 cases), embolizations for recurrence after clipping (10 cases), surgery for recurrent aneurysms after embolization (5 cases), bypass surgery before parent artery occlusion for giant aneurysm (4 cases), embolization for failed surgical attempt (1 case), and hematoma evacuation after coil embolization (1 case). The patients with multiple aneurysms tended to refuse multiple surgeries and select endovascular treatments. Failed endovascular attempt required emergency surgical clipping to reduce the risk of rebleeding. For recurrent aneurysm after clipping, endovascular treatment was less invasive and safer than surgery. In the ruptured cases, 55 (66.3%) showed mRs 0 to 2. In the unruptured cases, we experienced morbidity associated with procedure by thromboembolism (3 cases) and coil penetration (1 case). A supplemental combination of endovascular and surgical treatments should be considered to realize a positive outcome for cerebral aneurysms while considering the risks and benefits of each treatment.