Back to Search Start Over

Early retreatment after surgical clipping of ruptured intracranial aneurysms.

Authors :
Ito, Yoshiro
Yamamoto, Tetsuya
Tsuruta, Wataro
Matsumura, Akira
Ikeda, Go
Uemura, Kazuya
Komatsu, Yoji
Source :
Acta Neurochirurgica. Sep2017, Vol. 159 Issue 9, p1627-1632. 6p. 2 Color Photographs, 3 Charts.
Publication Year :
2017

Abstract

Background: Although a rerupture after surgical clipping of ruptured intracranial aneurysms is rare, it is associated with high morbidity and mortality. The causes for retreatment and rupture after surgical clipping are not clearly defined. Methods: From a prospectively maintained database of 244 patients who had undergone surgical clipping of ruptured intracranial aneurysms, we selected patients who experienced retreatment or rerupture within 30 days after surgical clipping. Aneurysm occlusions were examined by microvascular Doppler ultrasonography and indocyanine green video-angiography. Indications for retreatment included rerupture and partial occlusion. We analyzed the characteristics and causes of early retreatment. Results: Six patients (2.5%, 95% CI 0.9 to 5.3%) were retreated within 30 days after surgical clipping, including two patients (0.8%, 95% CI 0.1 to 2.9%) who experienced a rerupture. The retreated aneurysms were found in the anterior communicating artery (AcomA) ( n = 5) and basilar artery ( n = 1). Retreatment of the AcomA (7.5%) was performed significantly more frequently than that of other arteries (0.56%) ( p < 0.01). A laterally projected AcomA aneurysm (17.4%) was more frequently retreated than were other aneurysm types (2.3%). Cases of laterally projecting AcomA aneurysms tended to result from an incomplete clip placed using a pterional approach from the opposite side of the aneurysm projection. Conclusions: Despite developments, the rates of retreatment and rerupture after surgical clipping remain similar to those reported previously. Retreatment of the AcomA was significantly more frequent than was retreatment of other arteries. Patients underwent retreatment more frequently when they were originally treated for lateral type aneurysms using a pterional approach from the opposite side of the aneurysm projection. The treatment method and evaluation modalities should be considered carefully for AcomA aneurysms in particular. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00016268
Volume :
159
Issue :
9
Database :
Academic Search Index
Journal :
Acta Neurochirurgica
Publication Type :
Academic Journal
Accession number :
124620320
Full Text :
https://doi.org/10.1007/s00701-017-3245-6