Blog
About

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

How has the nationwide use of off-label experimental endovascular devices been allowed for two decades as first choice and sometimes the only alternative to conventional standard and advanced surgical techniques?

*

Surgical Neurology International

Medknow Publications & Media Pvt Ltd

Read this article at

Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Related collections

      Most cited references 9

      • Record: found
      • Abstract: found
      • Article: not found

      Current management of middle cerebral artery aneurysms: surgical results with a "clip first" policy.

      One response to randomized trials like the International Subarachnoid Aneurysm Trial has been to adopt a "coil first" policy, whereby all aneurysms be considered for coiling, reserving surgery for unfavorable aneurysms or failed attempts. Surgical results with middle cerebral artery (MCA) aneurysms have been excellent, raising debate about the respective roles of surgical and endovascular therapy.
        Bookmark
        • Record: found
        • Abstract: found
        • Article: not found

        Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms: US multicenter experience.

        Utilization of the Pipeline embolization device (PED) in complex ruptured aneurysms has not been well studied. We evaluated the safety and effectiveness data from five participating US centers.
          Bookmark
          • Record: found
          • Abstract: found
          • Article: not found

          Microsurgical management of incompletely coiled and recurrent aneurysms: trends, techniques, and observations on coil extrusion.

          With the growing volume of aneurysms treated with endovascular methods and the unavoidable risks of incomplete coiling or recurrence, the volume of coiled aneurysms requiring surgical management is growing. We present a consecutive surgical experience with previously coiled aneurysms to examine clinical trends, the phenomenon of coil extrusion, microsurgical techniques, and morphological features affecting clippability. During a 10-year period, 43 patients underwent surgical management of an incompletely coiled or recurrent aneurysm (Gurian group B). Most patients (88%) presented initially with subarachnoid hemorrhage, most commonly (28%) located in the anterior communicating artery, and 42% of aneurysms were large or giant sized. Twenty-one patients had incompletely coiled aneurysms and 22 patients had recurrent aneurysms, with a mean time to recurrence of 28 months. Coil extrusion was observed in 1 of the incompletely coiled (5%) and 12 of the recurrent aneurysms (55%). Overall, 33 aneurysms were clipped directly, 7 unclippable aneurysms were bypassed, and 3 were wrapped. Three patients died (surgical mortality, 7%), 1 patient (2%) experienced permanent neurological morbidity, and the remaining 39 patients (91%) had good outcomes (mean follow-up, 4.3 years). This study demonstrated a sharp increase in the incidence of coiled aneurysms requiring surgery, reflecting the increasing numbers of patients opting for endovascular therapy initially. Coil extrusion occurs more often than expected, is often misdiagnosed on angiography as simply compaction, and seems to be a time-dependent process not seen acutely. Direct clipping is the preferred microsurgical treatment of coiled aneurysms and may be predicted by the relationship between coil width and compaction height (C/H < 2.5, or a wedge angle < 90 degrees). We recommend a bypass strategy for unclippable coiled aneurysms because it can be executed methodically; has predictable ischemia times; and is associated with more favorable results than thrombectomy, coil extraction, and clip reconstruction.
            Bookmark

            Author and article information

            Affiliations
            Professor of Neurological Surgery and Anesthesiology, Ghaly Neurosurgical Associates, 4260 Westbrook Dr, Suite 127, Aurora, Illinois 60504, USA
            Author notes
            [* ]Corresponding author
            Contributors
            Journal
            Surg Neurol Int
            Surg Neurol Int
            SNI
            Surgical Neurology International
            Medknow Publications & Media Pvt Ltd (India )
            2229-5097
            2152-7806
            2015
            11 February 2015
            : 6
            4338484 SNI-6-22 10.4103/2152-7806.151262
            Copyright: © 2015 Ghaly RF.

            This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

            Categories
            Letter to the Editor

            Surgery

            Comments

            Comment on this article