Spontaneous Regression of Aneurysm Remnant after Incomplete Surgical Clipping in a Patient with Ruptured Cerebral Aneurysm

Cases of spontaneous regression of cerebral aneurysm remnant after incomplete surgical clipping have been rarely reported. This paper reports the regression of an aneurysm remnant after incomplete surgical clipping during postsurgical follow-up. A 50-year-old male presented with subarachnoid hemorrhage because of rupture of an anterior communicating artery aneurysm. An emergency clipping of the aneurysm was performed. A cerebral angiography, which was performed two weeks postoperatively, revealed an aneurysm remnant. The patient refused additional treatment and was discharged without apparent neurological deficit. One-year follow up cerebral angiography demonstrated a partially regressed aneurysm remnant.

Mortality and Morbidity of Aneurysmal Neck Clipping during the Learning Curve

OBJECTIVE: Young neurosurgeons need to focus on the mortality and morbidity of aneurysmal neck clipping to develop a personal experience with an initial series. METHODS: Total 88 aneurysms from 75 patients who underwent neck clipping by the same operator from 2001 to 2004 were reviewed. Patients were divided into three groups: first year (Group I), second year (Group II), and third year (Group III) in each group. Location of aneurysm, age, Fisher grade, Hunter-Hess grade (H-H grade), postoperative Glasgow outcome scale (GOS), and complications related to surgical procedures were evaluated with Chi-square and logistic regression analyses. RESULTS: Fourteen patients had complications related to surgery (18.7%). The major causes of mortality and morbidity related to surgery were cerebral infarction, hemorrhage and brain swelling due to intraoperative rupture, brain retraction and vasospasm. Among the 4 cases of mortality were 2 patients in Group I, 1 patient in Group II and 1 patient in Group III, and location of aneurysms were 2 internal carotid artery(ICA) and 2 posterior communicating artery(PCoA) aneurysms. There were 4 morbidity and new neurological deficits in Group I, 4 in Group II and 2 in Group III. Although mortality and morbidity during the learning curve had a statistical significance in H-H grade, age (>60 years old), and aneurysm location (especially ICA aneurysm) as variables, mortality mainly occurred in ICA and PCoA aneurysms. CONCLUSION: Experienced supervision or endovascular approach should be considered for the treatment of ICA and PCoA aneurysms during the learning curve.

Surgical Experience of Recurrent Hemorrhage from the Regrowth Cerebral Aneurysm after Initial Neck Clipping: Case Report / 대한뇌혈관외과학회지

The neck clipping of cerebral aneurysm is a well established treatment for the subarachnoid hemorrhage caused by aneurysmal rupture. However, incomplete clipping of an aneurysm may result in recurrent hemorrhage with serious or fatal consequence. Recently, two patients underwent reoperation for recurrent hemorrhage from the regrowth aneurysm after previous clipping operation. The technical obstacles to surgical treatment of these two patients were perianeurysmal adhesion or scar formation, presence of clip and coating agents and so on. One patient showed good outcome, another patient was dead by pneumonia. In order to detect regrowth of aneurysm, periodic examination is very important for the patient with remnant neck after aneurysm clipping operation.

Comparative Study of Treatment Results between Surgical Neck Clipping and Endovascular Coiling on the Ruptured Middle Cerebral Artery Aneurysms

OBJECTIVE: The treatment modalities of cerebral aneurysms mainly consist of surgical neck clipping of aneurysms and endovascular embolization. Through comparing of the treatment results between two methods especially focused on their complicatons, the authors present the efficacy of the treatment modality in ruptured middle cerebral artery aneurysms. METHODS: Patients who admitted due to ruptured middle cerebral artery aneurysm between January 1998 and December 2002 were selected. They have done surgical neck clipping or endovascular embolization which employed platinum coil. Treatment methods were chosen in random fashion. The patient's clinical state were determined before, during, and after the treatment by using Hunt and Hess grade and Glasgow outcome scale(GOS). According to Fisher grade was classified based on the amount of hemorrhage. Statistical analyses were done with Student t-test, Pearson's correlation coefficient, and Mann-Whitney U test. RESULTS: Average follow-up period was 24 months(5 days-36 months) in surgery group and 26 months(8 days-36 months) in endovascular embolization group. There was no statistical significance regard to sex, age, patient's Hunt and Hess grade on admission, the Fisher grade, and aneurysmal size. There was no significant difference between GOS of two groups in statistically(p>0.05). CONCLUSION: This comparative study of reveals no significant difference in neurologic outcomes between two treatment modalities.

Clinical Analysis and Surgical Treatment of Vertebral Aneurysm

Aneurysms of the vertebral artery are relatively uncommon. Diagnois and treatment of such condition aneurysm has a potentially higher degree of technical difficulty. We retrospectively analyzed the clinical features and therapentic outcomes of 12 consecutive patients with vertebral aneurysms that we have encountered during the last 11 years. Most of these aneurysms occured in females (9 of 12). Eight patients presented as classic subarachnoid hemorrhage, three were diagnosed incidentally, and the other one patient had fusiform aneurysm presented with mass effect. Among the 12, there were 7 saccular aneurysms, 2 fusiform aneurysms, and 3 dissecting aneurysms. Eight of these were located at the origin of the posterior inferior cerebellar artery(PICA), two were at the junction of the vertebral and basilar arteries, and two were at the distal portion of PICA. Direct neck clipping was performed in 8 patients and proximal ligation of the vertebral artery was done in 4 patients due to the impossibility of direct neck clipping. Eleven of them experienced no major morbidity. However, one patient with fusiform aneurysm treated by vertebral artery clipping developed right cerebellar hemispheric infarction. Unfortunately this patient died 10 months after surgery due to lung abscess related to Behcet's disease.

Outcome of Ruptured Intracranial Aneurysms Treated by Coating

In rare occasions in which aneurysmal neck clipping is nearly impossible, coating is employed. During the period from 1985 to 1992, 312 patients with aneurysm underwent surgery;aneurysmal neck clipping were performed in 284 cases while coating only in 28. The reasons that coating was required were;wide and broad neck in 13, perforators arising from the neck in 4, neck tearing during dissection in 3, very friable neck in 2, severe adhesion with surrounding structures in 3, and small aneurysm without enough room for clipping in 3. In twenty-three cases, cotton wisp and bioglue were used as coating materials. In another five cases, the aneurysmal wall was reinforced using Surgical or Gelfoam. Patients were followed for 24 months on average of all the patients. Four had last contack. Six died(4 due to rebleeding and 2 due to pneumonia). Fourteen were good and 4 were moderately disabled. There were no rebleeding incidences during first three months' follow-up after coating. We thus concluded that coating an aneurysm offers some protection from rebleeding, particularly when the rebleeding risk period is over.