Original ArticleTreatment of Recurrent Intracranial Aneurysms After Clipping: A Report of 23 Cases and a Review of the Literature
Introduction
Several studies have reported aneurysm regrowth at a previously clipped site,1, 2, 3, 4 and de novo aneurysm formation after clipping is an occasional but well-established occurrence.5, 6 Recurrent aneurysms have been treated with endovascular procedures7, 8, 9, 10, 11 and direct surgery,5, 9, 10, 12 but current reports have not discussed in detail the methods by which treatment procedures are chosen. Because the technical difficulties associated with reoperative procedures for recurrent aneurysms are well established,5 some authors have suggested endovascular coiling as a safe and effective retreatment option.7, 8, 9, 10, 11 Although progress in neuroendovascular procedures can make various complex aneurysms treatable,13, 14, 15 there are some cases of aneurysms deemed unsuitable for coil embolization, such as thrombotic aneurysms, giant aneurysms, and wide neck aneurysms. For these cases, we have had to perform a craniotomy procedure. These operations often require neurosurgeons to overcome the technical difficulties associated with severe adhesions when establishing an approach route and to create space around the aneurysm. In this article, we present 23 patients who had a recurrent aneurysm after clipping and underwent surgical interventions. These cases are thoroughly reviewed with a focus on direct surgical management.
Section snippets
Materials and Methods
The institutional review board approved this retrospective study; informed patient consent was not required. During the years 2004–2015, we performed 23 consecutive surgical procedures to treat saccular aneurysms that regrew at a previously clipped site. For patients with an aneurysm that required retreatment within 2 years after initial clipping, the initial treatments for these cases were regarded as having incomplete clipping, and the cases were excluded. Patient clinical records were
Patient Characteristics
Case summaries are presented in Table 1. Patients were 23–66 years old (mean ± SD, 49.0 years ± 13.1) at their first admission and 45–81 years old (mean ± SD, 64.5 years ± 10.8) at their second admission. Of the 23 patients, 19 were women. Recurrent aneurysms occurred 3–31 years (mean ± SD, 15.4 years ± 7.0) after the first operation. In 18 patients, the first clinical presentation was SAH; aneurysm was incidentally diagnosed in 5 asymptomatic patients. Aneurysm locations were as follows: 9 at
Discussion
Several authors have reported the use of coiling to treat aneurysms that recur after clipping7, 8 or have performed direct surgery to treat such aneurysms.5, 12 However, these reports have not clearly delineated the rationale behind the methods used to treatment recurrent aneurysms. Our institution has treated 23 cases of recurrent aneurysm. This report reviewed these cases with a focus on treatment strategies and outcomes. In our cohort, approximately half of the cases were relatively easy to
Conclusions
In our experience, coil embolization is a safe, effective, and very promising procedure for treating recurrent aneurysms, and it can be considered a first-line treatment option for suitable patients with recurrent aneurysms. In patients with aneurysms deemed unsuitable for coil embolization, surgical procedures often requires neurosurgeons not only to overcome the technical difficulties involved with reoperative clipping but also to perform technically demanding vascular reconstruction. For
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Retreatment of previously treated intracranial aneurysm: Procedural complications and risk factors for complications
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.