PT - JOURNAL ARTICLE AU - T. Ohta AU - I. Nakahara AU - R. Ishibashi AU - S. Matsumoto AU - M. Gomi AU - H. Miyata AU - H. Nishi AU - S. Watanabe AU - I. Nagata TI - The Maze-Making and Solving Technique for Coil Embolization of Large and Giant Aneurysms AID - 10.3174/ajnr.A4198 DP - 2014 Dec 26 TA - American Journal of Neuroradiology 4099 - http://www.ajnr.org/content/early/2014/12/26/ajnr.A4198.short 4100 - http://www.ajnr.org/content/early/2014/12/26/ajnr.A4198.full AB - BACKGROUND AND PURPOSE: Despite major progress in treating aneurysms by coil embolization, the complete occlusion of aneurysms of >10 mm in diameter (large/giant aneurysms) remains challenging. We present a novel endovascular treatment method for large and giant cerebral aneurysms called the “maze-making and solving” technique and compare the short-term follow-up results of this technique with those of conventional coil embolization. MATERIALS AND METHODS: Eight patients (65 ± 11.5 years of age, 7 women) with large/giant unruptured nonthrombosed cerebral aneurysm (mean largest aneurysm dimension, 19 ± 4.4 mm) were treated by the maze-making and solving technique, a combination of the double-catheter technique and various assisted techniques. The coil-packing attenuation, postoperative courses, and recurrence rate of this maze group were compared with 30 previous cases (conventional group, 65.4 ± 13.0 years of age; 22 women; mean largest aneurysm dimension, 13.4 ± 3.8 mm). RESULTS: Four maze group cases were Raymond class 1; and 4 were class 2 as indicated by immediate postsurgical angiography. No perioperative deaths or major strokes occurred. Mean packing attenuation of the maze group was significantly higher than that of the conventional group (37.4 ± 5.9% versus 26.2 ± 5.6%). Follow-up angiography performed at 11.3 ± 5.4 months revealed no recurrence in the maze group compared with 39.2% in the conventional group. CONCLUSIONS: The maze-making and solving technique achieves high coil-packing attenuation for efficient embolization of large and giant cerebral aneurysms with a low risk of recurrence.