Background and purpose Craniotomy with neck clipping or endovascular coiling is treatment modality for cerebral aneurysm. In general, coiling is faster and less invasive, but not able to remove the subarachnoid hemorrhage. It is well known that substances released from the blood from the subarachnoid hemorrhage and inflammatory process might be the main cause of vasospasm and hydrocephalus. Authors analyzed our data to compare the incidence of vasospasm and hydrocephalus according to treatment modalities.
Methods Total 1039 cerebral aneurysm patents (723 ruptured & 315 unruptured; among 723 ruptured cases, 320 patients clipped & 403 patients coiled) between March 2007 & February 2017, were include in this analysis. In this study, most MCA aneurysms were treated clipping while most posterior circulation aneurysms were treated coiling. Authors compare the incidence of vasospasm and chronic hydrocephalus, procedure time, neurologic improvement rate and re-treatment rate.
Results Vasospasm developed 10.6% in clipping and 5.5% in coiling group (p=0.007). Chronic hydrocephalus, need shunt operation, developed similar incidence in both groups (11.6% in clipping and 9.4% in coiling, p=0.208). The procedure time (from anesthesia induction to wake up time) was 114.8 minutes in coiling while it was 394.2 minutes in clipping group (p=0.000). Initial neurologic status was worse, but neurologic improvement (= eGCS - iGCS) was frequent in coiling group (57.6% in coiling and 40.9% in clipping, p=0.000). Re-treatment rate (p=0.238) were statistically no difference in both groups.
Conclusions From our study, mechanical irritation to the offending vessel might be the most important cause of vasospasm development while subarachnoid hemorrhage does not influence on the hydrocephalus development. Overall re-treatment rate after coiling and clipping was similar.
Disclosures Y. Won: None. D. Yoo: None.
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