Recurrent Intracranial Aneurysms After Successful Neck Clipping

Abstract

BACKGROUND: To report the authors' experience with recurrent aneurysms after primarily completely clipped cerebral aneurysms and discuss mechanisms of recurrence and recommended management. METHODS: Data were available for 1016 consecutive patients who underwent clipping of ruptured and unruptured aneurysms in a 15-year period from 1993-2007. RESULTS: Nine patients were treated for recurrent aneurysms after successful complete clipping of the initial aneurysms; six patients had initial surgery before 1992, and three patients underwent surgery during the study period. Mean elapsed time between the first clipping and the recurrence of aneurysm was 13.3 years ± 7.8. Repeat craniotomy was performed in seven patients, and six patients underwent reclipping of aneurysms with or without removal of the old clips. One patient was treated by construction of an extracranial-intracranial (EC-IC) bypass plus coating of the aneurysm. Endovascular occlusion of the parent artery was performed in one patient. One patient died without any intervention. Recurrent aneurysms could be classified into three types according to the relationship of the new aneurysm neck to the old clip. CONCLUSIONS: The incidence of recurrent aneurysms after complete clipping was approximately 0.02% per year; aneurysms recurred after 13.3 years on average with 25 years the longest duration from initial clipping to recurrence. Classification of recurrent aneurysms into three types might be helpful in selecting appropriate surgical management. patients underwent reclipping of the aneurysms with or without removal of the old clips.One patient was treated by construction of extracranial-intracranial EC-IC bypass plus coating of the aneurysm. Endovascular occlusion of the parent artery was performed in one patient and the rest one patient expired without any. Recurrent aneurysms could be classified into 3 types according to the relation of their new aneurysm neck to the old clip.Conclusion: Recurrent aneurysms after complete clipping occurred around 0.02 %/year and took place after a period of 25 years at longest and 13.3 years on the average.Classification of recurrent aneurysms into three types might serve to select their appropriate surgical management.

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

“…221 A recent study reported a lower incidence of hemorrhage, with only 2 patients (0.2%) having SAH and a total of 9 patients (0.9%) having recurrent aneurysms among 1016 aneurysms clipped over a 15-year period; however, follow-up was not routinely performed in this series, and thus, the true incidence of recurrence is unclear. 222 Given the inclusion of both UIA and RIA, these results may not be generalizable to UIA alone. Although overall reported rates of recurrence appear to be very low, the limited available data suggest that recurrence rates may increase with incompletely clipped aneurysms and longer lengths of follow-up.…”

Computerized Angiographic Occlusion Rating for Ruptured Clipped Aneurysms is Superior to Subjective Occlusion Rating

“…This allows planning of follow-up intervals and retreatment and the prediction of rebleeding risks. 2,3,5,7,11,12 Because the goal of surgical aneurysm therapy is total and permanent occlusion of the aneurysm, partial occlusion has been seen as a failure due to the potential consequences of recurrent aneurysm hemorrhage. 3,11 Factors like the size and shape of the reperfused aneurysm, the relation of the open aneurysm part to the parent vessel, and the challenge of predicting the risk of rebleeding have been widely discussed in the literature.…”

“…3,4 Aneurysm remnants are evaluated and followed up mostly by angiography. Multiple attempts have been made to categorize the great variety of different types of aneurysm remnants, 2,[5][6][7][8] but only a few articles have been published concerning the angiographic assessment details being used to delineate and quantify aneurysm remnants after aneurysm clipping. 2,4,9 All authors based the angiographic assessment on the criterion standard of the subjective occlusion rating (SOR).…”

Ruptured Cerebral Aneurysms: An Update

“…Case reports and series have found that even when aneurysms appear to be completely occluded after surgery, recurrence and rupture may occur later. The incidence of recurrent aneurysms after complete clipping was approximately 0.02% per year; aneurysms recurred after 13.3 years on average with 25 years the longest duration from initial clipping to recurrence [66] . Repeat craniotomy may be performed to prevent the rebleeding.…”