The choice of treatment method for unruptured cerebral aneurysm. Investigation from clinical outcome, angiographical result, duration of hospital stay, and cost for treatment.

To compare complications, anigographical results, duration of postoperative hospital stay and cost for treatment of surgical clipping and coil embolization in the treatment of unruptured cerebral aneurysm. One hundred and nine non-giant saccular aneurysms in 90 patients were treated by either endovascular treatment (E group) or direct surgery (S group) in our Neurosurgical Department between April 1996 and April 2002. The complications and angiographical results were reviewed. The duration of postoperative hospital stay and cost for the treatment were calculated from bills for health insurance for 38 operations and 12 embolizations in 47 patients whose aim of hospitalization was only treatment for their unruptured aneurysm. Neck clipping was performed for 89 aneurysms (S group), wrapping for four (S group), embolization using Guglielmľs detachable coils (GDCs) for 15 (E group), and failed embolization followed by clipping for one (E group). The postoperative temporary deficit (disappeared within one month) and permanent deficit was seen in five cases (6.7%) and in three cases (morbidity: 4.0%) of S group, and in one case (6.7%) and none (morbidity; 0%) of E group, respectively. No death was seen in both group (mortality; 0% in both group). The rate of angiographical complete occlusion of the aneurysm was significantly higher in S group (P= 0.015, 88% in S group vs 50% in E group). The post-operative hospital stay was significantly shorter in E group (P=0.000013, mean days: 17.1 in S group vs 6.3 in E group), but cost for treatment was rather cheep in S group (N.S., mean cost: 1684329 yen in S group vs. 2259011 in E group). This retrospective study suggested that surgical treatment may be less expensive treatment with higher rate of postoperative angiographical complete occlusion than coil embolization, and treatment-related complication rate was similar in both treatment.