Open Surgery for Recurrent Intracranial Aneurysms: Techniques and Long-Term Outcomes

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• 作者：Juri Kivelev¹ ; ² ; ^{j.v.kivelev@gmail.com} ; Rokuya Tanikawa² ; Kosumo Noda² ; Juha Hernesniemi⁴ ; Mika Niemelä ; ⁴ ; Katsumi Takizawa³ ; Toshiyuki Tsuboi² ; Nakao Ohta² ; Shiro Miyata² ; Junpei Oda² ; Sadahisa Tokuda² ; Hiroyasu Kamiyama²
• 关键词：Aneurysm clipping ; Bypass ; Recurrent aneurysms
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：96
• 期：Complete
• 页码：1-9
• 全文大小：3057 K
• 卷排序：96

文摘

After occlusion of an aneurysm, a patient may experience aneurysm regrowth at the same site or develop de novo aneurysms. We present our experience in microsurgery of recurrent aneurysms with analysis of long-term results.MethodsThe senior authors (R. T. and H. K.) performed recurrent aneurysm clipping on 44 patients at Teishinkai Hospital and Asahikawa Red Cross Hospital in Sapporo, Japan. Operative techniques included clipping only, clipping and protective bypass, trapping of aneurysm with bypass, proximal occlusion, and bypass. Postoperative outcome was analyzed retrospectively using the modified Rankin Scale.ResultsOur series included 10 men (23%) and 34 women (77%), with a mean patient age of 63 years (range, 7−82 years). Before primary treatment, 11 patients (25%) had a ruptured aneurysm, while 33 patients (75%) had an unruptured aneurysm. The mean follow-up time after primary surgery was 7.6 years (range, 0.8−25 years). At our department the treatment of recurrent aneurysm included the clipping in 19 patients (43%), clipping with bypass in 6 patients (14%), aneurysm trapping with bypass in 10 patients (23%), and proximal occlusion and bypass in 9 patients (20%). The mean follow-up time after surgical treatment of recurrent aneurysms stood at 3.5 years (range 0.1−9 years). Altogether, 37 patients (84%) experienced favorable outcomes at last follow-up examination (modified Rankin Scale scores 0 and 1).ConclusionsMicrosurgery of recurrent aneurysms may be performed safely and effectively, as shown by our study, in which 84% of patients experienced favorable results.