• Samantha Lorena Paganelli, AlejandroSebastián AníbalSADepartment of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil., Campos FilhoJosé MariaJMDepartment of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil., Hugo Leonardo Dória-Netto, and Feres Chaddad-Neto.
• Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
• World Neurosurg. 2022 Jul 1; 163: 39.

AbstractOne of the most popular treatment strategies for complex cerebral aneurysms with wide necks is stent-assisted coiling.1 Although it is a minimally invasive technique, it is associated with higher recurrence rates (approximately 20%) compared with surgical clipping.2 Recanalization is more common principally in ruptured aneurysms as well as in giant aneurysms, aneurysms located in the posterior circulation, aneurysms with a relatively wide neck morphology, and aneurysms followed for >1 year.2-6 Tirakotai et al. classified the indications for surgical treatment after coiling into 3 groups: 1) surgery of incompletely coiled aneurysms; 2) surgery for mass effects on neural structures; 3) surgery for vascular complications.7 Recanalization, if significant, often requires retreatment. Retreating with additional coils fails in perhaps 50% of cases.3 On the other hand, surgical clipping is complicated and difficult to perform. Recanalized aneurysms are categorized into 3 types: type I, coils are compressed; type II, coils are migrated; type III, coils are migrated, and multiple coils fill its neck or the parent artery. Direct clipping can be applied to types I and II, whereas trapping, wrapping, or auxiliary revascularization is required in type III.2 Coil extraction should not be attempted regularly because it is associated with high morbidity.8 In this three-dimensional video, we present the microsurgical treatment of a type I recanalized anterior communicating artery aneurysm, which in serial digital subtraction angiography control scans showed residual patency, progressive growth, and changes in its hemodynamic behavior (Video).Copyright © 2022 Elsevier Inc. All rights reserved.

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