Neck Clipping of Previously Clipped, Recurrent Intracranial Aneurysms: Removal of the Previous Clip for Full Exposure of the Aneurysm and Sparing of Perforating Arteries

DOI 13 References
  • ISHII Yosuke
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • IRIE Shinsuke
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • INAGAKI Toru
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • YAGI Kenji
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • SAITOU Osamu
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • RI Tejin
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • MITSUGI Toru
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • NAKAGAWA Hiroshi
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
  • SAITOU Koji
    Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital

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Other Title
  • クリッピング後再発脳動脈瘤に対するクリッピング術
  • ─Clip抜去による完全剝離と穿通枝温存─

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Description

Neck clipping is a well-established treatment for intracranial aneurysms. After neck clipping, there is a low, but considerable, risk of aneurysm recurrence. Treatment of previously clipped, recurrent aneurysms is one of the most difficult procedures in aneurysm surgery. Sharp dissection around the aneurysm is essential, and the previous clip must be removed to ensure complete obliteration of the aneurysm and to spare the perforating arteries. <br> We have experienced three cases of previously clipped, recurrent intracranial aneurysms. All three patients with recurrent aneurysms had suffered subarachnoid hemorrhage prior to initial neurosurgical treatment. The intervals between the initial clipping and treatment of the recurrent aneurysms were five, 20 and 32 years. Two of the three recurrent aneurysms were located in the middle cerebral artery while the other one was located in the internal carotid artery; all occurred distal to the clip tines. In all three cases, it was possible to expose the entire length of the previous clip and remove it without rupturing the aneurysm, and re-clipping was successfully completed without surgical complications. <br> Although a single straight clip had been applied during the initial surgery, we now think it is important to completely obliterate this part of the aneurysmal neck, so multiple clips were placed during the second treatment. We report our experience in surgical clipping of previously clipped, recurrent intracranial aneurysms. <br>

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