title: Treatment of Recurrent Intracranial Aneurysms After Clipping: A Report of 23 Cases and a Review of the Literature.
abstract: OBJECTIVE
  There are no established treatment strategies for aneurysms that recur after clipping. In this study, we present cases of patients who experienced recurrent aneurysms after clipping and subsequently underwent surgical intervention.
  
  
  METHODS
  Between 2004 and 2015, we surgically treated 23 aneurysms that recurred at a previously clipped site. Patient characteristics and clinical history were retrospectively reviewed.
  
  
  RESULTS
  Patients included 19 women and 4 men 45-81 years old. Aneurysms recurred 3-31 years (mean, 15.4 years) after the initial operation. For 18 cases, the first clinical presentation was a subarachnoid hemorrhage; aneurysms were incidentally diagnosed in 5 patients. Aneurysm locations were as follows: 9 on the internal carotid artery; 4 on the middle cerebral artery; 7 on the anterior communicating artery; 2 on the distal anterior cerebral artery; and 1 on the basilar artery. The reasons for retreatment included subarachnoid hemorrhage (n = 9) and aneurysm regrowth detected on follow-up examinations (n = 14). Endovascular treatment was performed in 10 cases, and direct surgery was performed in 13 cases (clipping in 8, clipping or trapping with bypass in 5). Various complex vascular reconstructions, including high-flow bypass and intracranial-intracranial in situ bypass, were performed for recurrent aneurysms.
  
  
  CONCLUSIONS
  In our experience, coil embolization is a safe and effective procedure for treating recurrent aneurysms. When cases are unsuitable for coil embolization, surgical treatment often requires neurosurgeons not only to overcome the general technical difficulty of reoperative clipping but also to perform challenging vascular reconstruction.
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan. Electronic address: karimasa@med.hokudai.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hokari
authors.affiliation: Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kazumara
authors.affiliation: Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.affiliation: Department of Neurosurgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Hokkaido, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ushikoshi
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Asaoka
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Itamoto
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yokoyama
authors.affiliation: Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan.
authors.forename: Tetsuaki
authors.initials: T
authors.lastname: Imai
authors.affiliation: Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Osanai
authors.affiliation: Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Bypass; Cerebral aneurysms; Clipping; Coil embolization; Recurrence