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World Neurosurg

Title:		Microsurgical Management of Intracranial Aneurysms After Failed Flow Diversion
Author(s):		Mbabuike N; Shakur SF; Gassie K; Srinivasan V; Mascitelli J; Abla A; Duckworth E; Kan P; Zenonos GA; Schirmer C; Charbel FT; de Olivera E; Morcos JJ; Lawton M; Tawk RG;
Address:		"Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA. Department of Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA. Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA. Department of Neurosurgery, University of Miami, Miami, Florida, USA. Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA. Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA; Institute of Neurological Sciences, Sao Paolo, Sao Paolo, Brazil. Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA. Electronic address: Tawk.rabih@mayo.edu"
Journal Title:		World Neurosurg
Year:		2020
Volume:		20190827
Issue:
Page Number:		e16 - e28
DOI:		10.1016/j.wneu.2019.08.121
ISSN/ISBN:		1878-8769 (Electronic) 1878-8750 (Linking)
Abstract:		"BACKGROUND: Flow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases. METHODS: We present a multicenter series of 13 aneurysms for which FD failed and that were subsequently treated with open surgery. We also present a review of the reported data regarding operative management of aneurysms after unsuccessful FD. RESULTS: Twelve patients with 13 aneurysms were included in the present study. All 12 patients had undergone surgery after FD because of persistent aneurysm filling, mass effect, or aneurysm rupture. The patients underwent aneurysm clipping and parent vessel reconstruction, decompression of the aneurysm mass, occlusion of proximal flow to the aneurysm, or aneurysm trapping with or without extracranial-intracranial artery bypass. CONCLUSIONS: Aneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise"
Keywords:		"Adult Aged Aneurysm, Ruptured/*surgery Cerebral Revascularization/methods *Endovascular Procedures Female Humans Intracranial Aneurysm/*surgery Male Middle Aged *Neurosurgical Procedures Treatment Outcome Aneurysms Bailout Flow diversion Microsurgery Oper;"
Notes:		"MedlineMbabuike, Nnenna Shakur, Sophia F Gassie, Kelly Srinivasan, Visish Mascitelli, Justin Abla, Adib Duckworth, Edward Kan, Peter Zenonos, Georgios A Schirmer, Clemens Charbel, Fady T de Olivera, Evandro Morcos, Jacques J Lawton, Michael Tawk, Rabih G eng 2019/08/31 World Neurosurg. 2020 Feb; 134:e16-e28. doi: 10.1016/j.wneu.2019.08.121. Epub 2019 Aug 27"