Original scientific paper

https://doi.org/10.20471/acc.2021.60.04.17

Microsurgical Management of Recurrent Intracranial Aneurysms Following Endovascular Treatment: a Single Institution Illustrative Case Series and Literature Review

Krešimir Rotim ; Department of Neurosurgery, Sestre milosrdnice University Hospital Canter, Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
Vladimir Kalousek orcid.org/0000-0002-1439-0930 ; Department of Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Filip Vrban ; Department of Neurosurgery, Sestre milosrdnice University Hospital Canter, Zagreb, Croatia
Bruno Splavski orcid.org/0000-0002-4483-9364 ; Department of Neurosurgery, Sestre milosrdnice University Hospital Canter, Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia

Abstract

Microsurgical clipping and endovascular coiling are both effective management
modalities for intracranial aneurysms, whereas recent procedures are mainly directed towards endovascular
treatment because of its minimally invasive nature. However, such a treatment has been associated
with a bigger risk of recurrent aneurysmal growth and re-bleeding urging a selection of optimal
strategies to overcome these hazards. It seems that the most appropriate method of choice is
microsurgical clipping, which is much more technically challenging due to recurrent aneurysm demanding
configuration created by the initial coiling. Herein, we present an illustrative institutional
case series of recurrent intracranial aneurysms following endovascular treatment, and discuss the controversies
and benefits of their subsequent microsurgical management, based on our experience and
on literature review. Considering the results reported in this paper, it seems that careful selective microsurgical
neck clipping with/without aneurysmal sac resection and coil extraction remains the preferred
management option for recurrent intracranial aneurysms, resulting in high obliteration rates,
long-term occlusion stability, and low morbidity/mortality. In conclusion, to bring a satisfactory outcome,
the multidisciplinary management of recurrent intracranial aneurysms after endovascular treatment
should be adjusted to aneurysm morphology/size/location, and individualized according to patient
needs.

Keywords

Intracranial aneurysm, recurrent; Endovascular treatment; Microsurgical clipping; Outcome

Hrčak ID:

275505

URI

https://hrcak.srce.hr/275505

Publication date:

1.12.2021.

Article data in other languages: croatian

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