Microsurgical removal of previously placed aneurysm clips and application of new clips for recurrent cerebral aneurysms. Technical note.

A technique is described for removing previously placed aneurysm clips and applying new aneurysm clips for the treatment of regrown or reruptured cerebral aneurysms in patients more than 10 years after the original clipping of the aneurysm neck. The adherent tissue covering previously placed clips is cut just on and alongside the clips themselves using a small scalpel. Using the clip applicator, gentle pressure is applied to open the clip blade as little as possible. The aneurysm clip is carefully slid out along the line where the clip blade has resided, and a new aneurysm clip is applied. The procedure was successfully accomplished in four patients. Whereas three of these patients had an uneventful postoperative course, the remaining patient experienced transient right oculomotor nerve palsy and left-sided motor weakness. The present technique is a useful procedure for treatment of regrown or reruptured cerebral aneurysms occurring a significantly long time after initial clipping of an aneurysm neck.