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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2018; 79(04): e93-e97
DOI: 10.1055/s-0038-1676454
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Early Intracranial Aneurysm Recurrence after Microsurgical Clip Ligation: Case Report and Review of the Literature

Serge Marbacher
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
,
Alexander Spiessberger
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
,
Michael Diepers
2   Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau (KSA), Aarau, Switzerland
,
Luca Remonda
2   Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau (KSA), Aarau, Switzerland
,
Javier Fandino
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
› Author Affiliations
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Publication History

23 March 2018

20 September 2018

Publication Date:
07 December 2018 (online)

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Abstract

Microsurgical clip ligation is considered a definitive treatment for intracranial aneurysms (IAs), resulting in low rates of local recurrence that range from 0.2 to 0.5% and a latency period that averages about a decade. Our case report describes an early asymptomatic recurrence (i.e., without sentinel headache or seizure) less than 1 year after this 20-year-old woman underwent clip ligation of a ruptured anterior communicating artery (AComA) aneurysm. At recurrence, the patient underwent coiling of the regrowth; follow-up imaging at 6 and 18 months demonstrated complete IA occlusion. To review the putative risk factors of this rare phenomenon, the authors searched the PubMed database using the keywords “intracranial aneurysm,” “recurrence,” and “clipping” in various combinations. In the seven cases identified, all occurred in initially ruptured IA, which was often at the AComA, and six of seven patients were younger than 50 years old. Although most IA remnants grow slowly, early recurrence may represent a more aggressive biological behavior that warrants special attention in younger patients, positive rupture status, and unintended remnant of any size. In such a constellation, early imaging follow-up within the first 6 months may be warranted to rule out early IA recurrence

Keywords

intracranial aneurysm - clipping - aneurysm recurrence - subarachnoid hemorrhage
 

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