Early retreatment after surgical clipping of ruptured intracranial aneurysms

被引:11
|
作者
Ito, Yoshiro [1 ]
Yamamoto, Tetsuya [1 ]
Ikeda, Go [2 ]
Tsuruta, Wataro [1 ]
Uemura, Kazuya [2 ]
Komatsu, Yoji [3 ]
Matsumura, Akira [1 ]
机构
[1] Univ Tsukuba, Dept Neurosurg, Fac Med, 1-1-1 Ten Nodai, Tsukuba, Ibaraki 3058575, Japan
[2] Tsukuba Med Ctr Hosp, Dept Neurosurg, Tsukuba, Ibaraki, Japan
[3] Univ Tsukuba Hosp, Hitachi Med Educ & Res Ctr, Hitachi, Ibaraki, Japan
关键词
Early retreatment; Surgical clipping; Ruptured intracranial aneurysm; Incomplete clip; Indocyanine green video-angiography; ANTERIOR COMMUNICATING ARTERY; INDOCYANINE GREEN-VIDEOANGIOGRAPHY; MICROSURGICAL MANAGEMENT; ENDOVASCULAR COILING; SURGERY; DOPPLER; TRIAL; ISAT;
D O I
10.1007/s00701-017-3245-6
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Although a rerupture after surgical clipping of ruptured intracranial aneurysms is rare, it is associated with high morbidity and mortality. The causes for retreatment and rupture after surgical clipping are not clearly defined. From a prospectively maintained database of 244 patients who had undergone surgical clipping of ruptured intracranial aneurysms, we selected patients who experienced retreatment or rerupture within 30 days after surgical clipping. Aneurysm occlusions were examined by microvascular Doppler ultrasonography and indocyanine green video-angiography. Indications for retreatment included rerupture and partial occlusion. We analyzed the characteristics and causes of early retreatment. Six patients (2.5%, 95% CI 0.9 to 5.3%) were retreated within 30 days after surgical clipping, including two patients (0.8%, 95% CI 0.1 to 2.9%) who experienced a rerupture. The retreated aneurysms were found in the anterior communicating artery (AcomA) (n = 5) and basilar artery (n = 1). Retreatment of the AcomA (7.5%) was performed significantly more frequently than that of other arteries (0.56%) (p < 0.01). A laterally projected AcomA aneurysm (17.4%) was more frequently retreated than were other aneurysm types (2.3%). Cases of laterally projecting AcomA aneurysms tended to result from an incomplete clip placed using a pterional approach from the opposite side of the aneurysm projection. Despite developments, the rates of retreatment and rerupture after surgical clipping remain similar to those reported previously. Retreatment of the AcomA was significantly more frequent than was retreatment of other arteries. Patients underwent retreatment more frequently when they were originally treated for lateral type aneurysms using a pterional approach from the opposite side of the aneurysm projection. The treatment method and evaluation modalities should be considered carefully for AcomA aneurysms in particular.
引用
收藏
页码:1627 / 1632
页数:6
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