Characteristics and management of residual or slowly recurred intracranial aneurysms

Abstract

Objective: Residual aneurysm from incomplete clipping or slowly recurrent aneurysm is associated with high risk of subarachnoid hemorrhage. We describe complete treatment of the lesions by surgical clipping or endovascular treatment.

Methods: We analyzed 11 patients of residual or recurrent aneurysms who had undergone surgical clipping from 1998 to 2009. Among them, 5 cases were initially clipped at our hospital. The others were referred from other hospitals after clipping. The radiologic and medical records were retrospectively analyzed.

Results: All patients presented with subarachnoid hemorrhage at first time, and the most frequent location of the ruptured residual or recurrent aneurysm was in the anterior communicating artery to posterior-superior direction. Distal anterior cerebral artery, posterior communicating artery, and middle cerebral artery was followed. Repositioning of clipping in eleven cases, and one endovascular treatment were performed. No residual aneurysm was found in postoperative angiography, and no complication was noted in related to the operations.

Conclusion: These results indicate the importance of postoperative or follow up angiography and that reoperation of residual or slowly recurrent aneurysm should be tried if such lesions being found. Precise evaluation and appropriate planning including endovascular treatment should be performed for complete obliteration of the residual or recurrent aneurysm.

Keywords: Intracranial aneurysm; Reoperation; Subarachnoid hemorrhage.

Fig. 1

A : Initial angiogram of a ruptured ACOA aneurysm. B : Intraoperative photograph depicting the residual aneurysm and slipped clip. C : Intraoperative photograph obtained after reposition of clip. D : Postoperative angiogram demonstrating a complete occlusion of aneurysmal remnant.

Fig. 2

A : Angiography obtained immediately after SAH, revealing an aneurysm of the ACOA. B : Postoperative angiogram demonstrating a residual, superiorly projecting aneurysm. C and D : Angiogram obtained after complete endovascular occlusion of the aneurysm remnant.

Fig. 3

A : Initial angiography showing the aneurysm on DACA. B : Immediate postoperative angiography demonstrating complete occlusion of the aneurysm. C : Angiogram obtained 3 years after clipping, revealing recurrence of the aneurysm. D : Postoperative angiogram exhibiting complete occlusion of the remnant sac.

Fig. 4

Management of recurrent or residual aneurysms.