부산대학교 도서관

Direct surgical clipping has long been the gold standard for the treatment of cerebral aneurysms. Since the development of endovascular treatment, management of intracranial aneurysms has become controversial. There are several merits and demerits in either mode of treatment. There are many in the literature advocating one or other, or combined treatment. In our study, we have tried to identify indications for either mode of treatment for incidental aneurysms.Endovascular treatment was introduced in Fujita Health University in 1994. From that time to the end of 1998, we had 566 cases of aneurysms, including 129 incidental aneurysms, which form the material of the present study. Ninety cases were treated by direct surgery. Thirty three cases were treated by endovascular intervention. Six cases were untreated.In the direct surgical group, all 90 patients with incidental aneurysms had excellent results except for one case impossible to approach, followed by coiling. In the endovascular intervention group, 6 had subarachnoid hemorrhage (SAH), including 1 death as a complication. Pseudoaneurysm developed in 1 case in the parent artery, which was embolized with coil. Coil embolization failed in 5 case-3 were followed by direct surgery, 1 was followed without surgery or intervention and 1 died due to ruptured aneurysm. Coil compaction occurred after 6 months in 2 cases that were reembolized.An advantage of endovascular treatment is that it does not depend on the site of the aneurysm or its relationship to surrounding vessels or nerves. Its disadvantage is in dealing with aneurysms with a wide neck or aneurysms involving branches or perforators. Therefore we examined the aneurysms in detail with 3D CT angiography, especially with endoscopic views. Adequate narrowing of the neck of the aneurysm is a good indication for endovascular coil embolization. However, if there is a nipple type of a bleb present it may rupture easily. As these aneurysms should be treated early and quickly, surgery is more reliable in such cases.Indication for direct surgery is incidental aneurysm with bleb or wide neck. Indications for endovascular coil embolization include: a) incidental aneurysm especially of basilar system without bleb with narrow neck and b) cases with other systemic complications.