Combined endovascular and microsurgical treatment of multiple cerebral aneurysms

  • D.V. Shchehlov SO «Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine», Kyiv, Ukraine
  • O.P. Hnelytsia SO «Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine», Kyiv, Ukraine
  • M.S. Gudym SO «Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine», Kyiv, Ukraine
  • O.E. Svyrydiuk SO «Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine», Kyiv, Ukraine
  • M.B. Vyval SO «Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine», Kyiv, Ukraine
Keywords: multiple cerebral aneurysms; endovascular treatment; microsurgical clipping; treatment results; combined treatment.


Recent advances in interventional neuroradiology brought all multiple cerebral aneurysms (MCA) could be occluded using endovascular techniques. A multimodal approach (combined microsurgical and endovascular) should be considered as a possible treatment option for MCA to improve treatment outcomes by simplifying the technical complexity of endovascular occlusion and providing sustained long-term occlusion.
Objective ‒ to analyze the results of combined microsurgical and endovascular treatment of MCA.
Materials and methods. A retrospective analysis of the results of evaluation and surgical treatment of 172 patients with MCA in Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine from April 2016 to February 2022. In 7 (4.1 %) patients, combined endovascular and microsurgical treatment of MCA was done.
Results. In 7 patients (4 women and 3 men, mean age ‒ 39.3 years), 19 aneurysms (size from 3 to 15 mm) were detected, of which 15 (78.9 %) were located in the anterior semicircle, 4 (21.1 % ) ‒ in the posterior. All aneurysms of the basilar circulation were excluded using endovascular approach. In 4 (57.1 %) patients, the aneurysms were ruptured. Ten (52.6 %) aneurysms were occluded endovascularly (6 with coil s only, 2 with balloon-assisted coiling, 1 with stent-assisted coiling, and 1 with flow-deverter stent), 9 (47.4 %) aneurysms were clipped. One (5.3 %) periprocedural complication after endovascular treatment was noted ‒ prolapse of the coil into the vessel. In 2 (22.2 %) cases, residual aneurysm was detected after clipping, which was occluded with coils. The rate of total aneurysm occlusion at discharge was 94.7 %. All patients were discharged from the hospital with favorable results (score ≤2 points on the modified Rankine scale). Stable effective occlusion after 3 months was noted in 17 (89.5 %) aneurysms, 2 (10.5 %) aneurysms were filled at the level of the neck.
Conclusions. Combined endovascular and microsurgical treatment is a technically feasible treatment option for MCA and is considered in patients where the conventional approach with either method has failed or is associated with a high risk of complications. Our series has demonstrated the safety and efficacy of combined MCA treatment.


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Rotim K, Kalousek V, Splavski B, Tomasović S, Rotim A. Hybrid microsurgical and endovascular approach in the treatment of multiple cerebral aneurysms: an illustrative case series in correlation with literature data. Acta Clin Croat. 2021 Mar;60(1):33-40. doi: 10.20471/acc.2021.60.01.05. PMID: 34588719; PMCID: PMC8305362.

Vajda J. Multiple intracranial aneurysms: a high risk condition. Acta Neurochir (Wien). 1992;118:59-75. doi: 10.1007/BF01400727

Shchehlov D, Gnelyca O, Vyval M, Sviridyuk O, Konotopchyk S. Current experience of the treatment of multiple cerebral aneurysms (literature review). Ukrainian Interventional Neuroradiology and Surgery. 2022;38(4):50-8. (in Ukrainian)

Chung J, Shin YS. Multiple intracranial aneurysms treated by multiple treatment modalities. Neurosurgery. 2011 Oct;69(4):E1030-2. doi: 10.1227/NEU.0b013e31822a5280. PMID: 21709595.

Choudhri O, Mukerji N, Steinberg GK. Combined endovascular and microsurgical management of complex cerebral aneurysms. Front Neurol. 2013 Aug 8;4:108. doi: 10.3389/fneur.2013.00108. PMID: 23964263; PMCID: PMC3737456.

Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK. Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol. 2012;33(1):159-63 doi: 10.3174/ajnr.A2719

Sanai N, Tarapore P, Lee AC, Lawton MT. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgeryю 2008:62(6):1236-49; discussion 49-53. doi: 10.1227/

Ryttlefors M, Enblad P, Kerr RS, Molyneux AJ. International subarachnoid aneurysm trial of neurosurgical clipping versus endovascular coiling: subgroup analysis of 278 elderly patients. Stroke. 2008;39(10):2720-6 doi: 10.1161/STROKEAHA.107.506030

Shimizu H, Inoue T, Fujimura M, Saito A, Tominaga T. Cerebral blood flow after surgery for unruptured cerebral aneurysms: effects of surgical manipulation and irrigation fluid. Neurosurgery. 2011;69(3):677-88; discussion 88, doi: 10.1227/NEU.0b013e3182195509

How to Cite
Shchehlov, D., Hnelytsia, O., Gudym, M., Svyrydiuk, O., & Vyval, M. (2022). Combined endovascular and microsurgical treatment of multiple cerebral aneurysms. Ukrainian Interventional Neuroradiology and Surgery, 39(1), 14-21.

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