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Original Article
Endovascular or Microsurgical Treatment of Intracranial Aneurysms: Single Center Analysis
Jin Wook Kim, Won-Bae Seung, Yong Seok Park
Kosin Medical Journal 2013;28(1):19-26.
DOI: https://doi.org/10.7180/kmj.2013.28.1.19
Published online: January 19, 2013

Department of Neurosurgery, Kosin University College of Medicine, Busan, Korea

Corresponding author: Yong Seok Park, Department of Neurosurgery, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Republic of Korea TEL: +82-51-990-6124 FAX: +82-51-990-3042 E-mail: ysparkns@kosinmed.or.kr
• Received: May 2, 2012   • Accepted: January 2, 2013

Copyright © 2013 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    The objective of this study was to assess effectiveness and outcomes of endovascular versus microsurgical treatment for intracranial aneurysms in single hospital.
  • Methods
    This was a retrospective study, using data collected during 4 year (between 2008 and 2011) from single hospital(Kosin University Gospel Hospital). A total of 274 treated, intracranial aneurysm cases were evaluated. The measurements used were effectiveness as measured by hospital discharge outcomes: 1) mortality (in-hospital death), 2) clinical outcomes(modified Ranking Scale: mRS).
  • Results
    Among total of 274 cases, unruptured intracranial aneurysm cases were 132 cases and ruptured cases were 142 cases. Among unruptured 132 cases, 65 cases were treated by microsurgical treatment and 67 cases were treated by endovascular treatment. Among ruptured 142 cases, 61 cases were treated by microsurgical treatment and 81 cases were treated by endovascular treatment. In unruptured cases, there was not any fatal complication and same adverse outcomes (3% versus 3%). In ruptured case, in regards of treatment modality (i.e., endovascular versus microsurgical treatment), each clinical outcomes were as followings; good clinical outcome was 53.1% (43/81) versus 41.0% (25/61), moderate clinical outcome was 13.6% (1/81) versus 9.8% (6/61), severe clinical outcome was 18.5% (15/81) versus 22.9% (29/142) and fatal outcome was 14.8 (12/81) versus 26.2% (16/61).
  • Conclusions
    This analysis of single hospital data indicates that endovascular therapy is associated with significantly less morbidity, less mortality, compared with conventional microsurgical treatment for all intracranial aneurysms. Endovascular therapy, as a treatment alternative to microsurgical clipping, should be offered as a viable therapeutic option for all patients considering treatment of an intracranial aneurysm.
  • Keywords: Endovascular; Intracranial aneurysm; Microsurgical
Table 1.
Distribution of sex according to the location of intracranial aneurysms
ACom PCom/ ACho MCA ICA DACA posterior circulation
M F T M F T M F T M F T M F T M F T
Ruptured 25 23 48 5 19 24 14 26 40 2 9 11 1 2 3 5 11 16
Unruptured 11 8 19 6 19 25 14 31 45 9 26 35 0 4 4 0 4 4
Total 36 31 67 11 18 49 28 57 85 11 35 46 1 6 7 5 15 20

ACom=anterior communicating artery, ACho=anterior choroidal artery, DACA=distal anterior cerebral artery, F=female, ICA=internal carotid artery, M=male, MCA=middle cerebral artery, PCom=posterior communicating artery, T=total.

Table 2.
Distribution of treatment modalities according to the location of intracranial aneurysms
ACom PCom / ACho MCA ICA DACA posterior circulation Total
Total coil 38 28 20 39 4 19 148
clip 29 21 65 7 3 1 126
Ruptured coil 27 19 13 5 2 15 81
clip 21 5 27 6 1 1 61
Unruptured coil 11 9 7 34 2 4 67
clip 8 16 38 1 2 0 65

ACom=anterior communicating artery, ACho=anterior choroidal artery, DACA=distal anterior cerebral artery, ICA=internal carotid artery, MCA=middle cerebral artery, PCom=posterior communicating artery.

Table 3.
Clinical outcome according to the treatment modality and the location of ruptured intracranial aneurysm
Location mRS 0 or 1 2 or 3 4 or 5 6
ACom Coil 15 4 5 3
Clip 9 3 7 2
MCA Coil 6 2 4 1
Clip 12 2 5 8
ICA Coil 3 0 1 1
Clip 1 0 1 4
PCom/ ACho Coil 10 4 3 2
Clip 2 1 1 1
DACA Coil 1 0 0 1
Clip 1 0 0 0
posterior circulation Coil 8 1 2 4
Clip 0 0 0 1
All location Coil 43 11 15 12
Clip 25 6 14 16
Total 68 17 29 28

ACom=anterior communicating artery, ACho=anterior choroidal artery, DACA=distal anterior cerebral artery, ICA=internal carotid artery, MCA=middle cerebral artery, mRS=modified Rankin scale, PCom=posterior communicating artery.

Table 4.
Clinical outcome according to the treatment modality and the Hund-Hess grade of ruptured intracranial aneurysm
H-H mRS 0,1 2,3 4,5 6
1,2 coil 35 6 7 1
clip 20 2 3 1
3 coil 7 3 0 3
clip 4 2 4 4
4 coil 1 2 8 6
clip 1 2 6 9
5 coil 0 0 0 2
clip 0 0 1 2
Total 68 17 29 28

H-H= Hund-Hess grade, mRS=modified Rankin scale.

Table 5.
Clinical outcome according to the size of ruptured intracranial aneurysm
size mRS 0 or 1 2 or 3 4 or 5 6
Coil < 5 mm 18 5 5 4
5-10 mm 23 5 7 7
>10 mm 2 1 3 1
Clip < 5 mm 13 2 6 6
5-10 mm 12 4 6 9
> 10 mm 0 0 2 1
Total 68 17 29 28

mRS=modified Rankin scale.

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        Endovascular or Microsurgical Treatment of Intracranial Aneurysms: Single Center Analysis
        Kosin Med J. 2013;28(1):19-26.   Published online January 19, 2013
        DOI: https://doi.org/10.7180/kmj.2013.28.1.19
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      Endovascular or Microsurgical Treatment of Intracranial Aneurysms: Single Center Analysis
      Endovascular or Microsurgical Treatment of Intracranial Aneurysms: Single Center Analysis

      Distribution of sex according to the location of intracranial aneurysms

      ACom PCom/ ACho MCA ICA DACA posterior circulation
      M F T M F T M F T M F T M F T M F T
      Ruptured 25 23 48 5 19 24 14 26 40 2 9 11 1 2 3 5 11 16
      Unruptured 11 8 19 6 19 25 14 31 45 9 26 35 0 4 4 0 4 4
      Total 36 31 67 11 18 49 28 57 85 11 35 46 1 6 7 5 15 20

      Distribution of treatment modalities according to the location of intracranial aneurysms

      ACom PCom / ACho MCA ICA DACA posterior circulation Total
      Total coil 38 28 20 39 4 19 148
      clip 29 21 65 7 3 1 126
      Ruptured coil 27 19 13 5 2 15 81
      clip 21 5 27 6 1 1 61
      Unruptured coil 11 9 7 34 2 4 67
      clip 8 16 38 1 2 0 65

      Clinical outcome according to the treatment modality and the location of ruptured intracranial aneurysm

      Location mRS 0 or 1 2 or 3 4 or 5 6
      ACom Coil 15 4 5 3
      Clip 9 3 7 2
      MCA Coil 6 2 4 1
      Clip 12 2 5 8
      ICA Coil 3 0 1 1
      Clip 1 0 1 4
      PCom/ ACho Coil 10 4 3 2
      Clip 2 1 1 1
      DACA Coil 1 0 0 1
      Clip 1 0 0 0
      posterior circulation Coil 8 1 2 4
      Clip 0 0 0 1
      All location Coil 43 11 15 12
      Clip 25 6 14 16
      Total 68 17 29 28

      Clinical outcome according to the treatment modality and the Hund-Hess grade of ruptured intracranial aneurysm

      H-H mRS 0,1 2,3 4,5 6
      1,2 coil 35 6 7 1
      clip 20 2 3 1
      3 coil 7 3 0 3
      clip 4 2 4 4
      4 coil 1 2 8 6
      clip 1 2 6 9
      5 coil 0 0 0 2
      clip 0 0 1 2
      Total 68 17 29 28

      Clinical outcome according to the size of ruptured intracranial aneurysm

      size mRS 0 or 1 2 or 3 4 or 5 6
      Coil < 5 mm 18 5 5 4
      5-10 mm 23 5 7 7
      >10 mm 2 1 3 1
      Clip < 5 mm 13 2 6 6
      5-10 mm 12 4 6 9
      > 10 mm 0 0 2 1
      Total 68 17 29 28
      Table 1. Distribution of sex according to the location of intracranial aneurysms

      ACom=anterior communicating artery, ACho=anterior choroidal artery, DACA=distal anterior cerebral artery, F=female, ICA=internal carotid artery, M=male, MCA=middle cerebral artery, PCom=posterior communicating artery, T=total.

      Table 2. Distribution of treatment modalities according to the location of intracranial aneurysms

      ACom=anterior communicating artery, ACho=anterior choroidal artery, DACA=distal anterior cerebral artery, ICA=internal carotid artery, MCA=middle cerebral artery, PCom=posterior communicating artery.

      Table 3. Clinical outcome according to the treatment modality and the location of ruptured intracranial aneurysm

      ACom=anterior communicating artery, ACho=anterior choroidal artery, DACA=distal anterior cerebral artery, ICA=internal carotid artery, MCA=middle cerebral artery, mRS=modified Rankin scale, PCom=posterior communicating artery.

      Table 4. Clinical outcome according to the treatment modality and the Hund-Hess grade of ruptured intracranial aneurysm

      H-H= Hund-Hess grade, mRS=modified Rankin scale.

      Table 5. Clinical outcome according to the size of ruptured intracranial aneurysm

      mRS=modified Rankin scale.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

      Table 5.

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