Recurrence of previously clipped anterior communicating aneurysm: The surgical techniques and strategies: A case series

Rajan Sharma; Ahmed Asiri; Yasuhiro Yamada; Tsukasa Kawase; Yoko Kato

doi:10.4103/ajns.AJNS_107_19

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(01): 120-125
DOI: 10.4103/ajns.AJNS_107_19

Original Article

Recurrence of previously clipped anterior communicating aneurysm: The surgical techniques and strategies: A case series

Authors

Rajan Sharma

¹Department of Neurosurgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

²Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
Ahmed Asiri

³Department of Neurosurgery, King Faisal Medical City, Abha
Yasuhiro Yamada

³Department of Neurosurgery, King Faisal Medical City, Abha
Tsukasa Kawase

³Department of Neurosurgery, King Faisal Medical City, Abha
Yoko Kato

³Department of Neurosurgery, King Faisal Medical City, Abha

Abstract

Background: Microsurgical aneurysm (MSA) clipping is considered as the standard therapy with the endovascular coiling. Microsurgical clipping is considered superior to endovascular in terms of the recurrence rate. The management of recurrent aneurysm following previous microsurgical clipping is challenging. The management of recurrent aneurysm following previous microsurgical clipping is challenging. This study aims to explore the management of recurrent aneurysm of the anterior communicating artery (ACoM). Materials and Methods: This is a case series of three elder women who had a recurrence of ACoM aneurysm after MSA clipping. All the three patients were operated with microsurgical clipping. We studied the preoperative images of the first surgery of all the patients. The detailed case-by-case analysis was performed based on preoperative, postoperative, and follow-up radiologic examinations and operative findings. Results: All three patients who had a recurrence after MSA clipping of ACoM aneurysm and were asymptomatic. At presentation, they were diagnosed at the postoperative imaging at follow-up. The earliest recurrence was 1 year while in one patient; the recurrence was detected 8 years after the initial MSA clipping. The cerebral aneurysms were posteriorly directed in the initial preoperative images in all the cases. Conclusion: This study revealed the recurrence as the residual neck or the enlargement of the aneurysm even after MSA in these cases of ACoM aneurysm. Even with the complete clipping, there can be recurrence at the clip site due to the change in hemodynamics over the time. We should follow-up the patients regularly even after microsurgical clipping.

Key-words:

Aneurysm - anterior communicating artery - management - microsurgical clipping - recurrence

Full Text

References

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