Masaaki Hokari1, Ken Kazumara2, Naoki Nakayama2, Satoshi Ushikoshi3, Taku Sugiyama4, Katsunori Asaoka4, Kazuki Uchida4, Daisuke Shimbo4, Koji Itamoto4, Yuka Yokoyama4, Masanori Isobe5, Tetsuaki Imai5, Toshiya Osanai2, Kiyohiro Houkin2. 1. Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan. Electronic address: karimasa@med.hokudai.ac.jp. 2. Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan. 3. Department of Neurosurgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Hokkaido, Japan. 4. Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan. 5. Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan.
Abstract
OBJECTIVE: There are no established treatment strategies for aneurysms that recur after clipping. In this study, we present cases of patients who experienced recurrent aneurysms after clipping and subsequently underwent surgical intervention. METHODS: Between 2004 and 2015, we surgically treated 23 aneurysms that recurred at a previously clipped site. Patient characteristics and clinical history were retrospectively reviewed. RESULTS: Patients included 19 women and 4 men 45-81 years old. Aneurysms recurred 3-31 years (mean, 15.4 years) after the initial operation. For 18 cases, the first clinical presentation was a subarachnoid hemorrhage; aneurysms were incidentally diagnosed in 5 patients. Aneurysm locations were as follows: 9 on the internal carotid artery; 4 on the middle cerebral artery; 7 on the anterior communicating artery; 2 on the distal anterior cerebral artery; and 1 on the basilar artery. The reasons for retreatment included subarachnoid hemorrhage (n = 9) and aneurysm regrowth detected on follow-up examinations (n = 14). Endovascular treatment was performed in 10 cases, and direct surgery was performed in 13 cases (clipping in 8, clipping or trapping with bypass in 5). Various complex vascular reconstructions, including high-flow bypass and intracranial-intracranial in situ bypass, were performed for recurrent aneurysms. CONCLUSIONS: In our experience, coil embolization is a safe and effective procedure for treating recurrent aneurysms. When cases are unsuitable for coil embolization, surgical treatment often requires neurosurgeons not only to overcome the general technical difficulty of reoperative clipping but also to perform challenging vascular reconstruction.
OBJECTIVE: There are no established treatment strategies for aneurysms that recur after clipping. In this study, we present cases of patients who experienced recurrent aneurysms after clipping and subsequently underwent surgical intervention. METHODS: Between 2004 and 2015, we surgically treated 23 aneurysms that recurred at a previously clipped site. Patient characteristics and clinical history were retrospectively reviewed. RESULTS:Patients included 19 women and 4 men 45-81 years old. Aneurysms recurred 3-31 years (mean, 15.4 years) after the initial operation. For 18 cases, the first clinical presentation was a subarachnoid hemorrhage; aneurysms were incidentally diagnosed in 5 patients. Aneurysm locations were as follows: 9 on the internal carotid artery; 4 on the middle cerebral artery; 7 on the anterior communicating artery; 2 on the distal anterior cerebral artery; and 1 on the basilar artery. The reasons for retreatment included subarachnoid hemorrhage (n = 9) and aneurysm regrowth detected on follow-up examinations (n = 14). Endovascular treatment was performed in 10 cases, and direct surgery was performed in 13 cases (clipping in 8, clipping or trapping with bypass in 5). Various complex vascular reconstructions, including high-flow bypass and intracranial-intracranial in situ bypass, were performed for recurrent aneurysms. CONCLUSIONS: In our experience, coil embolization is a safe and effective procedure for treating recurrent aneurysms. When cases are unsuitable for coil embolization, surgical treatment often requires neurosurgeons not only to overcome the general technical difficulty of reoperative clipping but also to perform challenging vascular reconstruction.
Authors: S-T Kim; J W Baek; S-C Jin; J H Park; J S Kim; H Y Kim; H W Jeong; Y G Jeong Journal: AJNR Am J Neuroradiol Date: 2018-12-20 Impact factor: 3.825
Authors: Alexander Romagna; Barbara Ladisich; Christoph Schwartz; Peter A Winkler; Al-Schameri Abdul Rahman Journal: Interv Neuroradiol Date: 2018-10-28 Impact factor: 1.610