Download PDF
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

Rajan Sharma
1   Department of Neurosurgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
2   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
,
Ahmed Asiri
3   Department of Neurosurgery, King Faisal Medical City, Abha
,
Yasuhiro Yamada
3   Department of Neurosurgery, King Faisal Medical City, Abha
,
Tsukasa Kawase
3   Department of Neurosurgery, King Faisal Medical City, Abha
,
Yoko Kato
3   Department of Neurosurgery, King Faisal Medical City, Abha
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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

Financial support and sponsorship

Nil.




Publication History

Received: 16 April 2019

Accepted: 04 October 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Dandy WE. Intracranial aneurysm of the internal carotid artery: Cured by operation. Ann Surg 1938;107:654-9.
  • 2 McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, et al. The barrow ruptured aneurysm trial. J Neurosurg 2012;116:135-44.
  • 3 Elijovich L, Higashida RT, Lawton MT, Duckwiler G, Giannotta S, Johnston SC, et al. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: The CARAT study. Stroke 2008;39:1501-6.
  • 4 Kang HS, Han MH, Kwon BJ, Jung SI, Oh CW, Han DH, et al. Postoperative 3D angiography in intracranial aneurysms. AJNR Am J Neuroradiol 2004;25:1463-9.
  • 5 Tsutsumi K, Ueki K, Morita A, Usui M, Kirino T. Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: Results of long-term follow-up angiography. Stroke 2001;32:1191-4.
  • 6 Wermer MJ, Greebe P, Algra A, Rinkel GJ. Incidence of recurrent subarachnoid hemorrhage after clipping for ruptured intracranial aneurysms. Stroke 2005;36:2394-9.
  • 7 Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, et al. Clipping versus coiling for ruptured intracranial aneurysms: A systematic review and meta-analysis. Stroke 2013;44:29-37.
  • 8 Feuerberg I, Lindquist C, Lindqvist M, Steiner L. Natural history of postoperative aneurysm rests. J Neurosurg 1987;66:30-4.
  • 9 Drake CG, Friedman AH, Peerless SJ. Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 1984;61:848-56.
  • 10 Renowden SA, Koumellis P, Benes V, Mukonoweshuro W, Molyneux AJ, McConachie NS. Retreatment of previously embolized cerebral aneurysms: The risk of further coil embolization does not negate the advantage of the initial embolization. AJNR Am J Neuroradiol 2008;29:1401-4.
  • 11 Ebina K, Suzuki M, Andoh A, Saitoh K, Iwabuchi T. Recurrence of cerebral aneurysm after initial neck clipping. J Neurosurg 1982;11:764-8.
  • 12 David AD, Vishten AG, Spetzler RF, Lemole M, Lawton MT, Partovi S. Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 1999;91:396-401.
  • 13 Washington CW, Zipfel GJ, Chicoine MR, Derdeyn CP, Rich KM, Moran CJ, et al. Comparing indocyanine green videoangiography to the gold standard of intraoperative digital subtraction angiography used in aneurysm surgery. J Neurosurg 2013;118:420-7.
  • 14 Papadopoulos MC, Apok V, Mitchell FT, Turner DP, Gooding A, Norris J. Endurance of aneurysm clips: Mechanical endurance of yaşargil and spetzler titanium aneurysm clips. Neurosurgery 2004;54:966-72.
  • 15 Kim P, Jang SJ. Management of recurrent cerebral aneurysm after surgical clipping: Clinical article. J Korean Neurosurg Soc 2018;61:212-8.
  • 16 Feuerberg I, Lindquist C, Lindqvist M, Steiner L. Natural history of postoperative aneurysm rests. J Neurosurg 1987;66:30-4.
  • 17 Sato S, Suzuki J. Prognosis in cases of intracranial aneurysm after incomplete direct operations. Acta Neurochir (Wien) 1971;24:245-52.
  • 18 Lin T, Fox AJ, Drake CG. Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 1989;70:556-60.
  • 19 Giannotta SL, Litofsky NS. Reoperative management of intracranial aneurysms. J Neurosurg 1995;83:387-93.