Introduction: Aneurysm regrowth after clipping or coiling might be associated with SAH risk. In this study, we present our experience in microsurgical treatment of recurrent aneurysms with analysis of long-term results.
Methods: Between January 2005 and February 2014 in Sapporo, Japan, the senior authors (R.T. and H.K.) performed recurrent aneurysm clipping in 44 patients. Patients with a recurrent aneurysm were included in the study regardless of the primary treatment modality (clipping or coiling). Postoperative outcome was analyzed retrospectively using the modified Rankin outcome scale.
Results: Our series included 10 men (23%) and 34 women (77%), with a mean patient age of 63 years (range, 7 to 82 years). Before primary treatment, 11 patients (25%) had aneurysm rupture, while 33 patients (75%) had an unruptured aneurysm. Initially, aneurysm was clipped in 22 patients (50%), coiled in 20 patients (46%), wrapped in one patient (2%), and secured with proximal ligation of parent artery in one patient (2%). The mean follow-up time after primary surgery was 7.6 years (range, 0.8 to 25 years). The treatment of recurrent aneurysm included the clipping only (19 patients - 43%); clipping with protective bypass (six patients -14%); aneurysm trapping with bypass (ten patients - 23%); and proximal occlusion and bypass (nine patients - 20%). The mean follow-up time after re-operation was 3.5 years (range 0.1 to 9 years). Altogether, 37 patients (84%) experienced favorable outcome at last follow-up (mRankin score 0 and 1). Notably, all patients with small aneurysms and 19 of 21 patients (91%) with medium-sized aneurysm were neurologically intact (p = 0.049). Thirty of 34 patients (89%) with anterior circulation aneurysms and 7 of 10 (70%) patients with posterior circulation aneurysms experienced favorable postoperative outcome.
Conclusions: Microsurgery of recurrent aneurysms may be performed safely and effectively, as shown by our study, where 84% of patients experienced favorable results.
Patient Care: Our research emphasizes the value of surgical treatment of recurrent aneurysms, especially in cases when endovascular treatment is not appropriate.
Learning Objectives: By the conclusion of this session, participants should be able to describe the advantages and disadvantages of open surgery for recurrent aneurysms.