Recurrent subarachnoid hemorrhage after complete obliteration of intracranial aneurysm

Abstract

The authors report a case of recurrent subarachnoid hemorrhage (SAH) after complete occlusion of an intracranial aneurysm. It is known that regrowth of an aneurysm after the complete clipping is a rare event. For detection of recurrence, however, it may be necessary to follow up with the patient regularly after the initial operation for intracranial aneurysms, because re-rupture of an aneurysm can cause a fatal result, and the cumulative risk of a recurrent SAH is thought to be not low over time.

Keywords: Complete occlusion; Intracranial aneurysm; Recurrence; Subarachnoid hemorrhage.

Fig. 1

Preoperative (A) angiograms of the initial anterior communicating artery aneurysm and intraoperative inspection (B) of the first operation through the left pterional approach showing preclipped initial anterior communicating artery aneurysm directed superiorly (Rt A1 = A1 segment of right anterior cerebral artery; Lt A1 = A1 segment of left anterior cerebral artery). An : aneurysm, ON : optic nerve.

Fig. 2

Postoperative angiograms of the initial anterior communicating artery aneurysm. Postoperative angiogram after the first clipping shows no residual neck.

Fig. 3

Preoperative (A) angiogram of recurrent anterior communicating artery aneurysm at 6.5 years after the first surgery (arrow head = recurrent aneurysm) and intraoperative view (B) of the second operation through the left pterional approach showing the recurrent aneurysm located near the clip of the previous operation, with some distance, and directed anteriorly. ACA : anterior cerebral artery, An : aneurysm, Clip : previous clip in the first clipping, ON : optic nerve.

Fig. 4

Postoperative angiogram of recurrent anterior communicating artery aneurysm at 6.5 years after the first surgery. Postoperative angiogram after the second clipping shows complete occlusion of the newly developed aneurysm.