Surgical treatment for recurrent intracranial aneurysms after primary interventional embolization

Abstract

Objective To assess the efficacy and safety of surgical treatment for recurrent intracranial aneurysms after primary interventional embolization. Methods A total of 15 patients with recurrent aneurysms after primary interventional embolization who were diagnosed and treated in Tianjin Huanhu Hospital from June 2014 to June 2019 were included. The aneurysms located in anterior communicating artery (ACoA, one case), middle cerebral artery (MCA, 2 cases), internal carotid artery (ICA) cavernous sinus segment (one case), supra clinoid process segment (2 cases) and posterior communicating segment (5 cases), basilar artery (BA, 2 cases), posterior inferior cerebellar artery (PICA, 2 cases). There were 5 large aneurysms (＞25 mm in diameter), 3 large aneurysms (10-25 mm in diameter), and 7 small aneurysms (＜10 mm in diameter). Surgical treatment was performed on all patients. Results Surgery was performed successfully in all patients, with a success rate of 100%. Seven patients underwent bypass surgery [external carotid artery (ECA)⁃radial artery (RA)⁃M2 bypass (2 cases), superficial temporal artery (STA)⁃M4 bypass (one case), occipital artery (OA)⁃PICA bypass (2 cases), and STA⁃posterior cerebral artery (PCA) P2 bypass (2 cases)] and 7 patients underwent clipping surgery, and carotid narrowing surgery was performed in one patient. In 15 patients 13 (86.67%) had favorable outcome [modified Rankin Scale (mRS) ≤ 2]. One case (Case 6) had cerebral infarction after clipping. One case (Case 11) had no significant relief of compression symptoms after superficial temporal artery (STA)⁃posterior cerebral artery (PCA) low flow posterior circulation bypass, and died of pulmonary infection 11 months after follow⁃up. Conclusions Operations for recurrent aneurysms after interventional embolization are difficult surgery, such surgeries are recommended in high⁃volume centers, with sufficient experience in both clipping and cerebral bypass. Bypass surgery is an effective means of dealing with recurrent complex aneurysms.

doi：10.3969/j.issn.1672⁃6731.2021.07.008