The Management of Residual and Recurrent Intracranial Aneurysms After Previous Endovascular or Surgical Treatment—a Report of Eighteen Cases.

Abstract

We review our experience with patients harbouring putaminal intracerebral haematoma treated by intraoperative ultrasound guided aspiration and thrombolysis with Urokinase. We assessed the feasibility and safety of the procedure and compared the results with a similar group of patients previously treated in our unit by craniotomy and clot evacuation. From September 1998 to May 2000, eighteen consecutive patients with putaminal haemorrhage without suspected underlying structural aetiology or coagulopathy were included. Under general anesthesia, a catheter was inserted into the centre of the haematoma through a frontal burr hole under ultrasound guidance. An external ventricular catheter was also inserted for intracranial pressure monitoring. After maximally aspirating the haematoma, the catheter was left in place and 30 000 units of urokinase instilled. Further instillation of 20 000 units of urokinase was performed every 12 hours. The resolution of haematoma was followed with serial CT scan. The mean age was 55 years; mean haematoma size was 50 mL. The mortality rate was 11% (2/18); both deaths were not procedure related. Twenty-four patients were in the craniotomy; there were three deaths (13%). Other outcomes of the two groups were similar. We concluded that ultrasound guided aspiration and thrombolysis appears safe and effective in treating putaminal haemorrhage.Various methods and material have been used to treat cranium bifidum. We report the use of split calvarium bone graft in the treatment of the condition in a 3-year-old girl with a large bilateral parietooccipital defect. Early follow up reveals satisfactory results. 4.

Retreatment of Previously Embolized Cerebral Aneurysms: The Risk of Further Coil Embolization Does Not Negate the Advantage of the Initial Embolization

“…Other surgical series report 4% completely unclipped and 4% incompletely clipped aneurysms, 14 and Feuerberg et al 15 found 3.8% incidence of aneurysm rests after clipping and reported a 3.7% incidence of rebleeding in these patients. Successful coil embolization of surgical remnants is, of course, also described 16,17 and was also our experience (unpublished observations by Renowden and McConachie;2007).…”

Endovascular management of recurrent anterior communicating aneurysm previously embolized. Case presentation

“…Progressive neck remnant enlargement has been demonstrated in 14.8% of aneurysms in the first year after treatment and a major recurrence in B C D 20.7% at a mean of 16.48 ± 15.93 months. The other authors detected 46.9% of all recurrences by 6 months and 96.9% by 36 months [1,2,5]. The complication rate following aneurysms retreatment by endovascular retreatment ranged from 0% to 11% in previous reported series.…”

“…Nevertheless, coil mass compactation was not constantly associated with aneurysm recurrence. There have been many situations where the coil compaction phenomenon has been stable over time without any evolution to an aneurysm recurrence that would impose a type of reintervention [1,2,3]. In the situations of aneurysmal enlargement without signs of coil compactation, the mechanisms of aneurysm recurrence were defined as regrowth.…”

“…If a stable occlusion is documented angiographically, follow-up conventional angiography was recommended after another 12 to 36 months. If stable occlusion was confirmed in post-embolization angiography performed after 1 to 2 years, follow-up was continued by noninvazive imaging studies [1,2].…”

Observer Agreement Regarding the Necessity of Retreatment of Previously Coiled Recurrent Cerebral Aneurysms

“…9 Our understanding of the natural history of aneurysm remnants and recurrences continues to evolve. Even though aneurysm retreatment is entrenched as a widely accepted routine procedure for recurrent aneurysms, 8,10,11 the angiographic criteria that define a "need to retreat" have received little or no attention in the literature. 12 As best we can tell, the ability to place additional coils into a recurrent aneurysm cavity likely is 1 criterion, especially for endovascular retreatment considerations.…”