Surgical and endovascular combined modality of treatment for aneurysms

ABSTRACT

Most of the aneurysms can be treated successfully with either surgery or endovascular modality alone. But, some complex aneurysms can be better managed with surgical and endovascular combined modality of treatment. This study was done to review combination options, their indications and outcome. Articles in English literature on surgical and endovascular combined modality of treatment for cerebral aneurysms were reviewed and analyzed based on Pubmed search. Followed combination options were used Surgery followed endovascular therapy 1. Extracranial to intracranial bypass surgery followed by endovascular parent vessel occlusion. 2. Aneurysm clipping assisted by temporary balloon occlusion with/without suction decompression. 3. Intentional partial clipping for neck reconstruction followed by endovascular aneurysm packing. 4. Clipping as the first treatment. Regrown or partially clipped aneurysm obliterated by endovascular packing. Endovascular therapy followed by surgery 1. Partial coiling to prevent rebleed followed by delayed definitive clipping. 2. Permanent parent vessel occlusion followed by surgery for decompression in giant aneurysm. 3. Coiling as the first treatment, reanalyzed aneurysm treated with clipping. 4. Coiling and clipping of multiple remote aneurysms. In various published series; combined modality of treatment has shown better results in complex aneurysms as compared to either of the modality alone with less morbidity. Surgical and endovascular combined modality is very useful addition to the armamentarium for the management of complex aneurysms and can be applied in various combinations. When used rationally, this approach offers the best outcome with reduction of treatment morbidity