Recurrent A n eu rysm after C o il Em b o lizatio n

Kazuo Mizoi, M.D., Takashi Yoshimoto, M.D.,
Akira Takahashi, M.D., Yoshihide Nagamine, M.D.

ru ptu re of the aneu ry sm is still u n set­
tled. R ecently, w e treated a patient w ho
required surgical repair of a recu rren t
aneurysm 18 m on ths after the en d ov as­
cular treatm en t w ith G u g lielm i d etach ­
able coils (G D C s) (5, 6). This com m u n i­
cation
d etails
u n expected
su rgical
com p lications in treating such a recu r­
rent an eurysm and presen ts the histo­
logical find ings of the su rgically re­
sected
recurren t aneurysm , w hich
show ed enlargem ent o f the sm all rem ­
nant after electro throm bo sis treatm ent.

Department of Neurosurgery (KM, TY), Tohoku University School of Medicine, and
Departments of Neurosurgery (YN) and Intravascular Neurosurgery (AT), Kohnan Hospital,
Sendai, Japan

CASE REPORT

OBJECTIVE A N D IM PO RTA N CE: This case report details the unexpected
surgical difficulty encountered in treating a recurrent aneurysm after coil
embolization and presents the histological findings of the resected aneurysm.
This is only the second reported case of histological description of an
aneurysm after coil embolization in a human.
CLINICAL PRESEN TA TIO N : A 60-year-old woman experienced a 3-month
history of chronic headache. Neuroimaging studies demonstrated a 2-cm
anterior communicating artery aneurysm. The aneurysm was treated with a
two-stage endovascular coil embolization, resulting in almost complete oc­
clusion of the aneurysm. A cerebral angiogram at 6-month follow-up dem­
onstrated slight refilling of the aneurysm, and angiography at 18 months
showed a marked increase in the size of the small remnant. Therefore, the
patient was referred for direct surgical repair of the aneurysm.
INTERVENTION: The distal aneurysm dome, which had been packed with
the coils and thrombus, was resected under temporary arterial trapping. An
intra-aneurysmal endarterectomy was required, because the aneurysm wall
developed intimal dissection that extended to the orifices of afferent and
efferent arteries. The aneurysm was then obliterated with multiple clips,
reconstructing the patent vessel lumen. However, the patient awoke from
surgery with left hemiparesis. A postoperative angiogram disclosed occlusion
of the right anterior cerebral artery. An histological study of the thrombosed
aneurysm showed that the luminal surface of thrombus was not lined by
endothelium.
CO N CLU SIO N : This case demonstrated not only the limited efficacy of coil
embolization treatment for wide-necked aneurysms but also the potential
difficulty in the direct surgical repair for such recurrent aneurysms. (N e u ro ­
surgery 39:165-169, 1996)
Key words: Cerebral aneurysm, Detachable coils, Embolization

A lthough end ovascu lar therapy is at* V r a c t i v e as a m inim ally invasiv e ap ­
proach for treating intracranial a n eu ­
rysms, it is not w ithou t m orbid ity

related to the procedure itself. In ad di­
tion, the problem regarding the long­
term efficacy of this technique in pre­
venting subsequent grow th and/or

N e u ro su rg e ry , Vol. 39, No. 7, July 1996

A 60-year-old w om an w as referred to
our facility for en d ovascu lar treatm ent
of a large unru p tu red an terior com m u ­
nicatin g artery (A C om A ) aneurysm ,
w hich w as d iscovered by rou tine neu ­
roim agin g stud ies for a 3-m onth history
of persistent head ache. A n giogram s
show ed a 2.0-cm global A C om A aneu ­
rysm w ith a w ide n eck of 6 m m (Fig.
1A). Because the A l seg m en t of the right
anterior cerebral artery is hypoplastic,
the aneurysm and bilateral d istal an te­
rior cerebral arteries w ere visualized
only by a left carotid angiogram .

Endovascular procedure
E nd ovascu lar em bolization w as per­
form ed in tw o stages, u sin g G D C s. At
the first op eration, nine coils w ere in tro­
duced
into the aneurysm
lum en
through tran sfem oral catheterization
un der system ic anticoagu lation. A p o st­
op erative angiogram d em onstrated al­
m ost total obliteration o f the aneurysm ,
w ith a sm all rem nant of the neck. O ne
m onth later, in the seco nd -stag e op era­
tion, three ad ditional coils w ere placed
into the aneurysm al rem nant w ith a sat­
isfactory result (Fig. IB ). T he patient
show ed no new neurological deficits af­
ter both procedures.

Follow-up results
At the 6-m onth follow -up exam in a­
tion, a partial refilling of the aneurysm
neck w as identified. Th e patien t w as
scheduled for further follow -up e v alu a­
tion. At the 18-m onth review , angiogra-

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A Pitfall in the Surgery of a Recurrent
Aneurysm after Coil Embolization and Its
Histological Observation: Technical
Case Report

1 65

166

i

M izo i et al.

phy dem onstrated a m arked increase in
the size o f the previously identified
sm all rem nant (Fig. 1C). Therefore, the
patient w as referred for direct surgery
of the aneurysm .

Operation

FIG U R E 1. A,
left carotid
angiogram
showing a large
ACom A
aneurysm. B,
postembolization
angiogram
demonstrating
almost complete
occlusion of the aneurysm. C, follow -up
angiogram at 18 months post­
em bolization, show ing recurrence of
the aneurysm.

F IG U R E 2. Intraoperative photograph
show ing the A C om A aneurysm packed
with numerous coils and organized
thrombus. This thrombosed aneurysm
had to be opened and resected for a
better visualization of the surrounding
arteries.
right anterior cerebral artery w ere v isu ­
alized through lep tom en in geal an asto ­
m osis from the left p o sterior cerebral
artery.
The right hem iparesis grad ually im ­
proved over several w eeks, b u t w eak ­
ness (three-fifths) of the right low er ex ­
trem ity persisted. The patien t w as
d ischarged 1 m onth after surgery for
rehabilitation at anoth er hospital.

Histological study
H em atoxylin and eosin- and M as­
son 's trichrom e-stain ed sections d em on ­
strated that the aneurysm w all w as reg ­
ularly thickened by d en se sclerous
collagen, w ith d isap p earance of the m e­
dia and the internal elastic lam ina. The
intralum inal throm bus contain in g the
platinum coils w as poorly organized
w ithout fibrous tissu e form ation. T here
w as no end othelial proliferation co v er­
ing the lum inal surface of the throm bus
(Fig. 4). This w as also confirm ed by an
im m u nohistochem ical stain w ith Factor
VIII.

D ISC U SSIO N
A m ong several en d ovascu lar tech ­
niques for the treatm ent of aneurysm s,
coil em bolization is recently thought to
be the m ost prom ising approach. H ow ­
ever, the success rate and long-term ef­
ficacy of this recent techniqu e is still
unknow n. C asasco et al. (2) reported 71
patients with ruptured cerebral a n eu ­

N e u ro su rg e ry , Vol. 39, No. 7, July 7996

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At the operation, the entire d om e of
the aneurysm w as exposed through a
bifrontal interhem ispheric approach.
The aneurysm neck w as located on the
lateral side of the right A 1 -A 2 junction,
fed from the A C om A (Fig. 2). By placing
tem porary clips on the A C om A and
right A l and A2 segm ents, the an eu ­
rysm w as com pletely trapped. The
dom e w as then incised. T he d om e w as
packed with relatively fresh and nonor­
ganized throm bus, w ith nu m erou s coils
(Fig. 3). It seem ed that the lum inal sur­
face of throm bus w as not lined by
the endothelium . D uring the rem oval
of the throm bus, d issection of the
thickened intim al layer d eveloped,
w hich extended to the orifices of affer­
ent and efferent arteries. Therefore,
intra-aneu rysm al end arterectom y w as
required. M ultiple clips w ere placed on
the base of the aneurysm , reconstructing
the sufficient vessel lum en of afferent
and efferent arteries. A fter surgery,
how ever, the patient presented w ith left
m otor w eakness. P ostoperative angiog­
raphy dem onstrated occlusion of the
right A2 segm ent. D istal segm ents of the

ry sm s that w ere treated by endovasa
lar tech n iq u es, w ith the use of Dacror
coated m icrocoils. O f 71 aneurysms,
(85% ) w ere com p letely occluded ar
the oth er 11 (15% ) w ere m ore than 90
occlu d ed . H ow ever, follow -up angio
rap h y, w ith a m ean follow -up period c
13 m o n th s, d em on strated the recurred
of an eu ry sm s in 3 o f the 60 complete!
occlud ed an eu ry sm s and in 3 of the 1
resid u al a n eu ry sm s. Sim ilar cases wit
recu rren t or p artially recanalized aneu
ry sm s after coil em bo lization have bee;
reported (7 -9 ).
G u g lielm i et al. (5) reported an exper
im en tal stu d y in w h ich a side-wall an
e u ry sm w as su rg ically constructed in
the com m on carotid artery of swine ant
treated by coil em bo lization . Histologi
cal ob servation d em onstrated that tht
neck of the an eu ry sm is entirely oc­
clu d ed by org an ized throm bus, and the
free lu m inal su rface seem s to be totalh
lined by en d oth eliu m . There are also
several exp erim en tal stu d ies that dem
on strate the intim al proliferation over
the p latin u m coils (3, 4, 10).
O nly w hen such intim al overgrowth
across the aneurysm neck is developed
can the aneurysm be evaluated as com
pletely isolated from the circulation
H ow ever, M olyneux et al. (13) recently
reported autopsy studies in two patients
with
w ide-necked
giant aneurysm1treated by G D Cs. A lthough autopsies of
these patients w ere perform ed at rela­
tively short periods after endovascular
treatm ent (2 and 6 m o, respectively), nei­
ther aneurysm dem onstrated evidence ot
endothelialization of the aneurysm neck
In the present case, as well, the unorga­
nized intra-aneurysm al throm bus was di­
rectly exposed to the blood circulation
w ithout neointim al form ation. In such a
situation, the effect of arterial blood pres
sure acting on the intra-aneurysmal
throm bus is essentially sim ilar to that in
balloon em bolization (water-hammer el
feet) (11). Subsequently, the coils can bt
pushed by the arterial pressure and be
com e com pacted toward the aneurysm
d om e (coil com paction), with further e*
pansion of the aneurysm . Guglielmi et
(7) stressed that dense packing with coib
is essential for the endovascular treatmo1'
o f aneurysm s, because the densely
packed coils bridge the intim al defect am’
prevent aneurysm redevelopm ent. How'

Recurrent An eu rysm after C o il Em b o lizatio n

ever, they also report a clear relationship
between the aneurysm neck size and
treatment results; am ong 79 aneurysm s,
complete aneurysm throm bosis w as ob­
served in 85% of the sm all-necked aneu­
rysms and in 15% of the w ide-necked an­
eurysms (14). In this report, 4 m m was
determined to be the discrim inative value
for small and wide necks.
For subsequent treatm ent o f recurred
aneurysms after coil em bo lization , the
choice of the ap p rop riate m an ag em en t
option is still controv ersial. C asasco et
al. (1) and K nuckey et al. (9) reported
cases for which coils w ere u sed for su b ­
sequent treatm ent. H ow ever, it seem s it
would be d ifficult and u n reaso n able to
try to com pletely occlu d e the w id e­
necked recurrent aneu rysm b ecau se re­
peated results can be an ticip ated . C o n ­
sequently, for the p resen t case, w e
selected direct surgery for su b seq u ent
treatment of the aneurysm . N ev erth e­
less, in this case, d issection o f the th ick ­
ened intimal wall occu rred d u ring the

rem oval of the intralum inal clot. Intraaneurysm al end arterectom y w as per­
form ed, but it w as very d ifficu lt to pre­
serve the sm ooth lum inal surface
around the orifice of each vessel. Re­
cently, L itofsky et al. (12) also described
a sim ilar surgical com plication in a pa­
tien t w ith a giant internal carotid artery
aneu ry sm w ho experienced w orsen ing
visual d eficit after em bolization w ith
G D C s. In that case, the aneurysm w as
op ened and decom pressed by a com bi­
nation of end arterectom y and coil re­
m oval, as w as done in our case. H ow ­
ever, the attem pt at direct clipping of
the aneurysm resulted in occlusion of
the parent artery.
M ore recently, G urian et al. (8) re­
ported 21 patients w ho required subse­
q uent surgical treatm ent of cerebral an­
eurysm s after failed or incom plete
e n d ovascu lar em bolization. In five of
these cases, the aneurysm neck w as
p atent and pliable because the em bolic
agent (balloon or G D C s) had been com -

F IG U R E 4.
Photom icrograph of
the resected
aneurysm dome.
The aneurysm wall
was made of dense
sclerous collagen
tissue without
smooth muscle
cells. Fresh,
unorganized,
intra-aneurysmal
thrombus was seen
on the left. Note
the
thrombus
(hematoxylin
lack of endothelial lining over the luminal side of
ar|d eosin; original m agnification, x 4 0 ).
N e u ro su rg e ry , Vol. 39, No. /, July 1996

pacted into the aneu rysm al dom e. It is
likely that proper clip application can be
achieved w ithout d ifficu lty if em bolic
m aterial does not exist around the base
of the aneurysm . H ow ever, it seem s that
such a situation is u n com m on , p articu ­
larly w hen the aneurysm is d ensely
packed w ith n u m erou s coils and co n sid ­
erable tim e has elapsed sin ce the last
em bolization.
In conclu sion , the p resen t case im ­
plied tw o im portan t problem s w ith coil
em bolization of aneurysm s: 1) it is d if­
ficult to gain p erm anent ob literation of
w id e-necked aneurysm s u sing G D C s;
and 2) aneurysm surgery after coil em ­
b olization is hazard ou s becau se o f the
p resence of nu m erou s in tralu m in al coils
and blood clot, and there exists the po­
tential surgical pitfall of vessel occlu ­
sion. For the surgical treatm ent o f the
recurrent aneurysm after electro th rom ­
b osis, avoid ing the d ev elop m en t o f inti­
m al d issection seem s to be crucial.
Received, January 16, 1996.
A ccepted, February 6, 1996.
Reprint requests: Kazuo Mizoi, M.D., De­
partm ent of Neurosurgery, Tohoku Univer­
sity School of M edicine, 1-1 Seiryo-Cho,
Aoba-ku, Sendai, 980-77, Japan.

REFERENCES
1. Casasco A, Arnaud O, Gobin P, Aym ard A,
George B, Cophignon J, Merland JJ: Giant intra­
cranial aneurysm: Elective endovascular treat­
ment using m etallic coils. Neurochirurgie 38:
18-26, 1992.
2. Casasco AE, Aymard A, Gobin YP, Houdart E,
Rogopoulos A, G eorge B, Hodes JE, Cophignon
J, Merland JJ: Selective endovascular treatm ent
of 71 intracranial aneurysm s with platinum
coils. J Neurosurg 79:3-10, 1993.
3. Dawson RC, Krisht AF, Barrow DL, Joseph GJ,
Shengelaia GG, Bonner G: Treatm ent of exper­
imental aneurysm s using collagen-coated mi­
crocoils. Neurosurgery 36:133-140, 1995.
4. Graves VB, Partington CR, Rufenacht DA,
Rappe AH, Strother CM: Treatm ent of carotid
artery aneurysm s with platinum coils: An ex­
perimental study in dogs. AJNR Am J N euro­
radiol 11:249-252, 1990.
5. Guglielmi G, Vinuela F, Sepetka I, M acellari V:
Electrothrom bosis of saccular aneurysm s via
endovascular approach: Part 1— Electrochem i­
cal basis, technique, and experim ental results.
J Neurosurg 75:1-7, 1991.
6. Guglielmi G, Vinuela F, Dion J, Duckwiler G:
Electrothrom bosis of saccular aneurysm s via
endovascular approach: Part 2— Prelim inary
clinical experience. J Neurosurg 75:8-14, 1991.

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F IG U R E 3.
Photograph of the
resected dome,
looking into the
aneurysm lumen.
The relatively fresh
thrombus mixed
with coils was
tightly adherent to
the aneurysm
dome. It seemed
that there was no
intimal overgrowth
on the blood clot.

167

168

M izo i et al.

7. Guglielmi G, Vinuela F, Duckwiler G, Dion J,
Lylyk P, Berenstein A, Strother C, Graves V,
Halbach V, N ichols D, Hopkins N, Ferguson R,
Sepetka I: Endovascular treatment of posterior
circulation aneurysm s by electrothrom bosis us­
ing electrically detachable coils. J Neurosurg

1993.
11. Kwan ESK, Heilman CB, Shucart WA: Enlarge­
ment of basilar artery aneurysm s following bal­
loon occlusion: "W ater-ham m er effect"— Re­
port of two cases. J Neurosurg 7 5:963-968,1991.
12. Litofsky NS, Vinuela F, Giannotta SL: Progres­
sive visual loss after electrothrom bosis treat­
ment of a giant intracranial aneurysm: Case
report. Neurosurgery 34:548-551, 1994.
13. Molyneux AJ, Ellison DW, Morris J, Byrne J:
Histological findings in giant aneurysm s
treated with Guglielmi detachable coils: Report
of two cases with autopsy correlation. J Neuro­
surg 83:129-132, 1995.
14. Zubillaga AF, Guglielmi G, Vinuela F, Duck­
wiler GR: Endovascular occlusion of intracra­
nial aneurysm s with electrically detachable
coils: Correlation of aneurysm neck size and
treatment results. AJNR Am J Neuroradiol 15:
815-820, 1994.

CO M M ENTS

The authors concisely report a 60year-old patient w ith w hat seem s, an ­
giographically, to be a partially throm ­
botic anterior com m unicating aneurysm
o f large b u t not giant size. This lesion
w as sym ptom atic although unruptured.
The patient underw ent tw o em boliza­
tion procedures, w hich resulted in vir­
tually com plete obliteration of the aneu ­
rysm , as revealed by angiograph y. The
lesion recurred p rogressively over the
next 18 m onths, and a surgical proce­
dure w as then perform ed and com pli­
cated by intim al and aneurysm wall
thickening, leading to the occlusion of
an efferent branch.
G u glielm i d etachable coil (G D C ) em ­
bolization is now in w idespread use and
seem s to be expan ding in term s of fre­
quency and in term s of specific indica­
tions in the end ovascu lar radiological
com m unity. N eurosu rgeons are en­

N e u ro su rg e ry , Vol. 39, No. 7, lu ly 1996

ation. Such a p atient can be treatec
q u ick ly w ith G D C s, m inim izing the re
b leed in g risk and allow in g appropriat,
care should v aso sp asm develop. If re.
cu rren ce is d em on strated on subsequen
stu d ies and the p atien t seem s to be re
cov erin g from his or her illness, a cram
otom y could be perform ed at that tinn
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77:515-524, 1992.
8. Gurian JH, Martin NA, King WA, Duckwiler
GR, Guglielmi G, Vinuela F: N eurosurgical
management of cerebral aneurysm s following
unsuccessful or incom plete endovascular em ­
bolization J Neurosurg 83:843-853, 1995.
9. Knuckey NW, Haas R, Jenkins R, Epstein MH:
Thrombosis of difficult intracranial aneurysm s
by the endovascular placem ent of platinum Dacron microcoils. J Neurosurg 77:43-50, 1992.
10. Kwan ES, Heilman CB, Roth PA: Endovascular
packing of carotid bifurcation aneurysm with
polyester fiber-coated platinum coils in a rabbit
model. AJNR Am J Neuroradiol 14:323-333,

cou ntering the com plication reported in
this article w ith increased frequency. In­
tralum inal throm bosis is a con cep t that
is not new . D rake and M ullan (person al
com m unication) applied this approach
via open craniotom y several d ecad es
ago, only to note an alarm in g tend en cy
tow ard aneurysm recurren ce in the e n ­
suing m onths. That exp erien ce and
m ore recent experien ce w ith d etachable
balloons and G D C s bring into question
w h eth er this strategy is fu nd am entally
sound. If one has an oval d efect in an
arterial w all together w ith a h em od y ­
nam ic pred isposition tow ard an eu ry s­
mal grow th, can throm bosis o f that sac,
w ith or w ithout en d othelialization , p ro­
vid e
long-term
protection
ag ainst
recurren ce?
O nce an aneurysm recurs, the surgical
treatm ent can be extrem ely co m p li­
cated. In m y experien ce, w hen an a n eu ­
rysm is incom p letely treated and su r­
gery is then perform ed in the ensuing
days or w eeks, the resid ual filling is in­
tim ately associated w ith the n eck of the
aneurysm and surgical treatm en t is
straightforw ard. If, how ever, m onths
have passed, the fibrotic reaction to the
coils rend ers reconstru ction o f the neck
a significant problem .
It should be kept in m ind that this
p articu lar patient w ith a sym ptom atic
lesion could have been treated w ith a
single surgical proced u re w ith expected
m orbid ity in the range of 5 to 10%. The
reported strategy resulted in at least six
angiogram s, tw o em bolization pro ce­
d ures that likely required sep arate anes­
thetics, an open craniotom y, p ostop era­
tive neurological d eficit, 1 m onth in the
acute care hospital, and extended reh a­
b ilitation care. Th e financial, as w ell as
n eurological, im pact of this strategy
should n ot be overlooked.
It is m y op inion that the existin g lit­
eratu re regard ing the long-term stability
of G D C s d oes not supp ort this tech ­
nique as an alternate strategy com p ara­
ble with d irect surgical clipping w hen
surgery is deem ed feasible by an exp e­
rienced n eurosurgeon. O n the other
hand, the techniqu e seem s to be ex­
trem ely useful in com plicated situ a­
tions. An ou tstand in g indication is in
the poor-grade patient after su b arach ­
noid hem orrhage, in w hom delayed su r­
gery w ould be a reasonable con sid er­

An altern ativ e p atien t g roup would h
com prised o f th ose in d ivid u als who, be
cau se of associated m ed ical conditions
are not thou g h t to be good operative
can d id ates. O n the oth er hand, if gen
eral anesth esia is requ ired for GDC
p lacem en t, m uch o f the "m inim ally in­
v a siv e " ben efit o f interventional ther
apy is lost. In the clinical environments
w ith w hich I am fam iliar, the anesthesi­
o logist has b etter control of the patient it
card iac

or

p u lm o n ary

complications

shou ld d ev elop in the op erativ e suite as
op posed to the interv en tion al radiologi
suite.
T his is ob viou sly an exciting new
tech n olog ical d ev elop m en t that justifies
carefu l stud y. O n ly if carefu l follow-up
o f p atien ts so treated demonstrates
lon g -term "c u re " can end ovascu lar ther­
apy be con sid ered an effective alterna­
tive strateg y to p recise su rgical clipping
It is w ell know n that im p recise surgical
clip p in g often lead s to significant aneu­
rysm recu rren ce, and treatm ent of those
recu rren ces carries increased risk to the
patient. In m y op in ion , only when an
exp erien ced cereb ro v ascu lar surgeon
think s th at the atten d an t neurological
risks to the p atient are inord inately high
should prim ary en d o v ascu lar therapy
be initiated.

H . H u n t Batjer

C hicago, Illinois
U n fortu n ately , this is a highly repre­
sen tative case o f the p ro blem s that can
arise after su ccessfu l G D C embolization
Becau se coils do not incite endothelial
repair, an eu ry sm s that grow in a direct
line w ith the n orm al d irection of arterial
blood flow have a high tend ency to re­
cu r after su ccessfu l coil embolization. It
seem s that on ly a n eu ry sm s that are at a
right angle to the p aren t vessel have
good resu lts w ith long-term oblitera­
tion. A n eu ry sm s at the b asilar apex and
at the op h th alm ic level o f the carotid

Recurrent An eu rysm after C o il Em b o lizatio n
artery recur w ith n otoriou s frequency,

nal throm bosis are going to be m uch

even after com plete em bolization.

m ore com m on in patients w ho are op­

The difficulty w ith surgical treatm en t

erated on w ith preexisting coil m asses

of a recurrent aneurysm is also w ell rep ­

than w ith patients w ho are operated on
prim arily.

resented by this case report. W h en the
coils are present near the n eck region of

The introd u ction of G D C em boliza­
tion is a m ajor ad vance and a significant

clip the aneurysm w ith o u t op en in g the

part o f our arm am entariu m in dealing

dome and rem ovin g

the ob stru ctin g

w ith intracranial aneurysm s. H ow ever,

coils. This type of m an eu v er g reatly in ­
creases the risk of su rgical clip p in g , as

becau se of the problem s represented by
this case report, aneurysm s that are su r­

compared to clipping an an eu ry sm that

gically clippable should be surgically

has no intralum inal coil m ass. Intim al

treated unless there are m ajor m edical

dissection, air em bolu s, and in tra lu m i­

contrain dication s.

C oil

should be reserved for aneurysm s that
have been explored and found to have
sig nificant con train d ication s to clip p ing
or in patients w ith m ed ical or n eu ro lo g­
ical p roblem s that p reclud e safe surgical
p roced u res. A n eu rysm clip p ing is a
proven tech nology w ith w ell-kn ow n
long-term efficacy. T his techniqu e needs
to be offered to all ap p rop riate p atients.
C oil em bolization shou ld be reserved
for aneurysm w ith sig n ifican t technical
lim itations to safe clipping.

em bolization

R o b ert A. S o lo m o n
N ew York, N ew York

A N N O U N CEM EN T

International Society for the History of the Neurosciences
T h e Intern ation al Society for the H istory of the N eurosciences, Inc., w as founded by a
group o f n eu ro h isto rian s at a m eeting in M ontreal, C anada, in M ay 1995. Its m ission is
to p ro m ote the history o f the neurosciences by im proving com m unication and e d u ca­
tion am o n g n eu ro h isto rian s and to im prove the quality and quantity of w ork in the
field. W e h op e to attract participants from all of the clinical and experim ental neuro­
scien ces, as w ell as professional historians and others w ith related interests. T h ere will
be annu al m eetin g s (u su ally in the spring), w hich w ill be held in alternate years in
N orth A m erica and on an oth er continent (usually Europe). The Society 's official pu b­
lication is the Jou rn al o f the H istory o f the N eurosciences, w hose found er and continu in g
ed itor is F. C lifford R ose, M .D ., of the N eurological Centre, L ondon, England.
The fo u n d in g officers o f the Society inclu de President Stanley Finger, Ph.D . (P sych ol­
og y/ N eu ral Scien ce, W ash in gton U n iversity, St Louis, M O); P resid ent-E lect, Peter
K oehler, M .D . (N eu rology, De W ever H ospital, H eerlen, The N etherland s); D uane
H aines, P h.D ., Secretary (ad d ress below ); and Treasurer, Sam uel G reenblatt, M.D.
(N eu rosu rg ery , B row n U n iversity, Paw tucket, RI). A nnual dues of $95.00 (U.S. dollars)
inclu d e a su b scrip tio n to the Journal, published by Sw ets & Z eitlinger of Lisse, The
N etherlan d s. For inform ation and m em bership application form s, please contact D uane
H aines, Secretary ISH N , D ep artm ent of A natom y, U niversity of M ississippi M edical
C enter, 2500 N orth State Street, Jackson , M S 39216-4505. Tel: 601/ 984-1640. Fax: 601/
984-1655. e-m ail: d eh ain es@ fion a.u sm ed .ed u .

N e u ro su rg e ry , Vol. 39, No. 7, July 1996

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the aneurysm , it is alm ost im p ossible to

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