Treatment for Recurrent Cerebral Aneurysm.

Park, Joung Soo; Yim, Man Bin; Kim, IL Man; Lee, Chang Young; Son, Eun Ik; Kim, Dong Won

Original Article

Journal of Korean Neurosurgical Society 2003;33(5): 472-476.

Joung Soo Park, Man Bin Yim, IL Man Kim, Chang Young Lee, Eun Ik Son, Dong Won Kim

Department of Neurosurgery, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea.

ABSTRACT

OBJECTIVE
The aim of this study is to make a management strategy for the patients with recurrent cerebral aneurysm after surgery. METHODS: Over a 19-year period, 1, 546 patients were treated for a ruptured intracranial aneurysm surgically. Twenty-six of these patients(1.7%) were subsequently treated for regrowing aneurysm(8) or de novo aneurysm formation(26). Among them, twenty-three individuals who presented with recurrent subarachnoid hemorrhage underwent conventional angiography to detect the aneurysm recurrence. Three-dimensional computed tomographic angiography was performed in the remaining three patients who complained chronic headache. The mean age at the first surgery was 48.6 years. An interval ranging from 1 to 192 months(mean, 76.1 months) since the original treatment.
RESULTS
Total 34 recurrent aneurysms in 26 patients were treated by microsurgical clipping(29 cases), wrapping(1 case), and endovascular coiling(4 cases) as a second procedure. A satisfactory outcomes were achieved in twenty-one patients(80.8%) during a mean 69.5 months follow-up period. The most common site of the recurrence was the internal carotid-posterior communicating artery. Patients with de novo aneurysms are frequently hypertensive(61.1%) and younger in age(55.6%). CONCLUSION: The treatment of recurrent cerebral aneurysm could be performed effectively using direct operations and/or endovascular procedures.

Key Words: Cerebral aneurysm; Recurrence; Three dimensional computed tomographic angiography; Subarachnoid hemorrhage; Coil embolization; Clipping