Abstract
We reviewed the medium-term results of endovascular treatment of intracranial aneurysms
and compared patient selection and results with those of open surgery. Between January
1992 and December 1995, a total of 248 consecutive patients were treated for 297 aneurysms
(61 unruptured and 236 ruptured). 162 aneurysms in 142 patients (mean age, 48.5 years)
were treated microsurgically and 134 aneurysms in 106 patients (mean age, 54.2 years)
were treated by endovascular embolization with Guglielmi detachable coils (GDC). The
mean follow-up was 2.6 years (range, 1.5 to 4.5 years). There was no significant difference
in patient population and selection in terms of age, sex or location of aneurysms
between both methods. Both modalities achieved excellent results (defined as no neurological
deficit) in patients with unruptured aneurysms and with no or minor deficits after
subarachnoid hemorrhage (SAH) between 71% and 88%. Patients with moderate deficits
after SAH had excellent outcomes in 49% after open surgery, and 47% after embolization.
Poor grade patients had, equally, as well an acceptable as a pour outcome, between
0% and 50%. There was no significant difference between the outcome of surgical or
endovascular patients. We conclude that GDC embolization is not associated with a
higher risk of morbidity and mortality than open surgery. This risk may even be lower
for lesions in surgically unfavorable locations. The GDC technique is a less invasive,
effective option to prevent re-bleeding in early stage, even in poor-grade patients.
However, these encouraging medium-term results have to be confirmed by a longer observation
period.
Key words
Intracranial Aneurysm - Surgery - Embolization - Clinical Outcome
