title: Open Surgery for Recurrent Intracranial Aneurysms: Techniques and Long-Term Outcomes.
abstract: BACKGROUND
  After occlusion of an aneurysm, a patient may experience aneurysm regrowth at the same site or develop de novo aneurysms. We present our experience in microsurgery of recurrent aneurysms with analysis of long-term results.
  
  
  METHODS
  The senior authors (R. T. and H. K.) performed recurrent aneurysm clipping on 44 patients at Teishinkai Hospital and Asahikawa Red Cross Hospital in Sapporo, Japan. Operative techniques included clipping only, clipping and protective bypass, trapping of aneurysm with bypass, proximal occlusion, and bypass. Postoperative outcome was analyzed retrospectively using the modified Rankin Scale.
  
  
  RESULTS
  Our series included 10 men (23%) and 34 women (77%), with a mean patient age of 63 years (range, 7-82 years). Before primary treatment, 11 patients (25%) had a ruptured aneurysm, while 33 patients (75%) had an unruptured aneurysm. The mean follow-up time after primary surgery was 7.6 years (range, 0.8-25 years). At our department the treatment of recurrent aneurysm included the clipping in 19 patients (43%), clipping with bypass in 6 patients (14%), aneurysm trapping with bypass in 10 patients (23%), and proximal occlusion and bypass in 9 patients (20%). The mean follow-up time after surgical treatment of recurrent aneurysms stood at 3.5 years (range 0.1-9 years). Altogether, 37 patients (84%) experienced favorable outcomes at last follow-up examination (modified Rankin Scale scores 0 and 1).
  
  
  CONCLUSIONS
  Microsurgery of recurrent aneurysms may be performed safely and effectively, as shown by our study, in which 84% of patients experienced favorable results.
authors: Department of Neurosurgery, Turku University Hospital, Turku, Finland; Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan. Electronic address: j.v.kivelev@gmail.com.
authors: Juri
authors: J
authors: Kivelev
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Rokuya
authors: R
authors: Tanikawa
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Kosumo
authors: K
authors: Noda
authors: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors: Juha
authors: J
authors: Hernesniemi
authors: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors: Mika
authors: M
authors: Niemelä
authors: Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan.
authors: Katsumi
authors: K
authors: Takizawa
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Toshiyuki
authors: T
authors: Tsuboi
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Nakao
authors: N
authors: Ohta
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Shiro
authors: S
authors: Miyata
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Junpei
authors: J
authors: Oda
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Sadahisa
authors: S
authors: Tokuda
authors: Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors: Hiroyasu
authors: H
authors: Kamiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002648:Child; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007564:Japan; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aneurysm clipping; Bypass; Recurrent aneurysms