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Regrowth of aneurysm sacs from residual neck following aneurysm clipping

1989; American Association of Neurological Surgeons; Volume: 70; Issue: 4 Linguagem: Inglês

10.3171/jns.1989.70.4.0556

1933-0693

T. S. Lin, Allan J. Fox, Charles G. Drake,

Moyamoya disease diagnosis and treatment

✓ It is recognized that incomplet treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences. For this reason, patients treated at the authors' institution in whom a large portion of the aneurysm neck or sac remained after application of a clip or ligature have been subjected to reoperation. However, 1- to 2-mm residual necks seen in postoperative angiography have been thought to pose little risk. Some cases of aneurysms recurring from a narrow residual neck after clipping have been reported, and a few instances of recurrent aneurysm have been described after apparently complete occlusion of the neck (as observed angiographically or in the surgeon's judgment). In recent years, a surprising number of cases have been presented in which this seemingly unimportant remnant of the neck dilated over a long period to become a dangerous aneurysm. This finding stresses the importance of complete aneurysm occlusion and of postoperative angiography for the recognition of a residual aneurysm neck. This should be important not only in aneurysm clipping but also in the endovascular treatment of intracranial aneurysms with detachable balloons.