Microsurgical management of complications after coiling of cerebral aneurysms

As the methods of interventional neuroradiology become more widespread, the question of how to deal with the cerebral aneurysm, wehther with microsurgical clipping or endovascular embolization, has been more topical. Complications after coiling with GDC (Guglielmi detachable electrocoils) can be managed in selected patients microsurgically. In 4 cases out of 34 GDC coiled aneurysms, the micro surgery had to be indicated. Apart from the clinical and anatomical criteria, which are necessary for the indication of coiling, the loss of elasticity of coiled aneurysm must be considered. Meanly it acts like a tumor adhered on the vessel and could therefore occlude it. In case of vessel occlusion, immediate operative intervention is inevitable. It is recommended to perforate the fundus, remove the coils and clip the slac neck of the aneurysm. The attempt for precise preparation and clipping of the aneurysm without removing of coils may lead to the rupture of the aneurysmal neck. The neurosurgeon plays an indispensable role in the teamwork for the indication of coiling the aneurysm and as a matter of course in case of complication. The features of the aneurysm after being coiled and the possibilities of microsurgical management of complication followed endovascular embolization are discussed.