Microsurgical coil removal after coiling a carotid bifurcation aneurysm.

Department of Neurosurgery, Hospital de Força Aérea do Galeão, Rio de Janeiro RJ, Brazil; Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, USA; Department of Neurosurgery, Hospital São José do Avaí, Itaperuna RJ, Brazil; Chief of Department of Neurosurgery, Hospital de Força de Aérea do Galeão, Rio de Janeiro RJ, Brazil. Endovascular treatments have evolved rapidly in the past decade, and have become established as a treatment option for the management of cerebral aneurysms. Detachable coils represent a major technological advance in aneurysm treatment, although coils are not suitable for the treatment of all aneurysms. As the use of endovascular techniques, especially Guglielmi detachable coils, becomes more widespread, growing numbers of patients will require surgical intervention after endovascular treatment of their intracranial aneurysms. Despite the advances in endovascular technology, all techniques can be associated with treatment failures and serious complications. Increasingly, these patients will present to neurovascular centers for evaluation and further management, including those for whom endovascular treatment was completely unsuccessful, those who have been partially treated, and those who require surgery to deal with a complication of an endovascular treatment. The former group will simply undergo surgery and present no new challenge to the neurosurgeon. However, the latter two groups will require surgical clipping of aneurysms that were previously coiled. This report describes surgical coil removal in a patient with a large carotid bifurcation aneurysm who had undergone coiling, after which the coil mass protruded into the parent artery, obstructing the middle cerebral artery flow.