Guidelines for the management of intracranial aneurysms at Macquarie University Hospital
This page is intended for the use of Nursing staff and Medical staff at Macquarie University Hospital, Sydney
Clipping versus coiling of unruptured aneurysms
Surgery is considered the first choice for:
-Middle cerebral artery location. -Size greater than 14 mm. -Multiple aneurysms where a single exposure can allow all aneurysms to be repaired. -Aneurysms downstream from occluded artery. -Patient age less than 55 years. -Need for ongoing antiplatelet or anticoagulant therapy. -If diagnositic DSA is unnecessary or undesirable.
GDC coiling is considered the first choice for:
-Patient age greater than 65 years and the aneurysm is less than 15 mm in size with a neck-to-fundus ration of 1:2 and the neck is less than 4 mm in size. -Heavily calcified neck identified on CT scan. -Posteriorly projecting basilar and posteriorly projecting ACoA aneurysms. For aneurysms that do not fit clearly into either of the above general recommendations:
Consideration needs to be given to the immediate risks of the procedure, the immediate effectiveness of the procedure and the long-term durability of the procedure. These factors will influence whether surgery or coiling is recommended.
Clipping versus coiling of ruptured aneurysms
Surgery is considered the first choice for:
-Life threatening intracerebral haemorrhage with rapidly declining neurological state. -Middle cerberal artery location. -Size greater than 14 mm. -Multiple aneurysms where a single exposure can allow all aneurysms to be repaired. -Aneurysms downstream from occluded artery. -Need for ongoing antiplatelet or anticoagulant therapy. -If diagnositic DSA is unnecessary or undesirable. GDC coiling is considered the first choice for:
-Single non-MCA aneurysm less than 15 mm in size with a neck-to-fundus ration of 1:2 and the neck less than 4 mm in size. -Heavily calcified neck identified on CT scan. -GCS <13 with ventriculomegaly (after EVD). -Poor neurological state in the absence of mass lesions. -Greater than 80 years of age