A Comparative Study of Microsurgical Clipping and Endovascular Coiling in the Treatment of Ruptured Cerebral Aneurysms

Sung, Jae Kyung; Koh, Hyeon Song; Kwon, Hyon Jo; Choi, Seung Won; Kim, Seon Hwan; Song, Shi Hun

Abstract

OBJECTIVE
Recently the treatment of endovascular coil embolization is gradually increasing compared to the traditional method of microsurgical clipping. However, both methods carry certain risks. The aim of this study was to compare each method's morbidity and complications in patients with ruptured cerebral aneurysms.
METHODS
We investigated patients who underwent surgery for subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture between January 2007 to December 2009 in our hospital. Patients' medical records and radiologic images were referenced and initial grade, location and size of aneurysm, treatment method, complications, prognosis, hospital stay and the cost were retrospectively investigated. We divided the patients into two groups according to surgical
METHODS
clipping group and coiling group. Treatment results were evaluated using Modified Rankin Scale (MRS).
RESULTS
Total 187 aneurysms were treated in 149 patients. Sixty-five and 84 patients were classified as clipping group and coiling group, respectively. The ratio of patients with good outcome in clipping vs. coiling was 83.6% vs. 80.8%. The incidence of vasospasm was significantly lower in the coiling group compared to the clipping group. The length of hospitalization was shorter in the coiling group. The cost and operation time was also less in the coiling group. However, higher numbers of remnant sac and coil compaction were observed in the coiling group.
CONCLUSION
Endovascular coil embolization for ruptured cerebral aneurysms had fewer vasospasms and complications. Also, it reduced the hospital stay, operation time, and cost compared with the clipping group. So, in addition to traditional microsurgical neck clipping, we think that endovascular coiling is a good alternative method to treat ruptured aneurysms.