Embolization of intracranial aneurysm using Guglielmi detachable coils

Objective To investigate the indication, preoperative evaluation, technical tip, prevention and treatment of complications, effect, and clinical use of the embolization of intracranial aneurysms by using GDCs. Methods From July 1998 to February 2000,93 patients with 118 intracranial aneurysms were embolized using GDCs, including 84 ruptured aneurysms (Hunt-Hess grade, Ⅰ 18 cases, Ⅱ 29 cases, Ⅲ 25 cases, Ⅳ 10 cases, Ⅴ 2 cases). 72 patients were treated at emergency, and 48 patients had CTA examination preoperatively. The operations were completed under the DSA monitoring. Continuous lumbar subarachnoid drainage was instituted and standard 3H treatment was given postoperatively. Results Total occlusion was achieved in 104 aneurysms(88 14%), over 90% in 11aneurysms(9.32%), less than 90% in 3 aneurysms(2 54%), with 3 patients (3/93, 3 23%) died in the cohort. One case rebleeded after 1.5 months and was cured by surgical clipping, 2 patients experienced enlargement of the aneurysmal neck and were reembolized. Following-up was performed from 2 to 22 months, 1 had severe disability, 7 had mild neurological deficit symptoms. Conclusion The results of short-term follow-up suggested that embolization of intracranial aneurysms with GDCs be microtraumatic, safe, effective, and reliable. Partial packing may result in continuous enlargement, rupture, and bleeding, while tight coil packing in aneurysms was reliable. The ruptured aneurysms need emergency embolization, and postoperative continuous lumbar subarachnoid drainage can enhance curative effect significantly.