Abstract
ObjectiveAneurysm residuals after clipping are a well-known problem, but the course of aneurysm remnants in follow-up is not well studied. No standards or follow-up guidelines exist for treatment of aneurysm remnants. The aim of this study was to evaluate the risk factors for postoperative aneurysm remnants and their changes during follow-up.MethodsWe performed a retrospective analysis of 666 aneurysms treated via clipping in our hospital from 2006 to 2016. Postoperative and follow-up angiographic data were analyzed for aneurysm remnants and regrowth. Clinical parameters and aneurysm-specific characteristics were correlated with radiological results.ResultsThe frequency of aneurysm residuals was 12% (78/666). Aneurysms located in the middle cerebral artery (p = 0.02) showed a significantly lower risk for incomplete aneurysm occlusion. Larger aneurysms with a diameter of 11–25 mm (p = 0.005) showed a significantly higher risk for incomplete aneurysm occlusion. Five patients underwent re-clipping during the same hospital stay. Remnants were stratified based on morphological characteristics into “dog ears” (n = 60) and “broad based” (n = 13). The majority of the “dog ears” stayed stable, decreased in size, or vanished during follow-up. Broad-based remnants showed a higher risk of regrowth.ConclusionsA middle cerebral artery location seems to lower the risk for the incomplete clip occlusion of an aneurysm. Greater aneurysm size (11–25 mm) is associated with a postoperative aneurysm remnant. The majority of “dog-ear” remnants appear to remain stable during follow-up. In these cases, unnecessarily frequent angiographic checks could be avoided. By contrast, broad-based residuals show a higher risk of regrowth that requires close imaging controls if retreatment cannot be performed immediately.
Highlights
The frequency of incomplete aneurysm occlusion after surgical clipping varies from 2–49% in different surgical series [1,2,3,4,5, 7, 9, 12, 13, 15, 20, 24, 25, 27, 28, 31, 32]
Acta Neurochir (2021) 163:131–138 rebleeding after aneurysm clipping is estimated at 1.3% and is associated with the size of the residual rest [19]
In 492 patients, a total of 666 ruptured and unruptured aneurysms were treated between April 2006 and December 2016
Summary
The frequency of incomplete aneurysm occlusion after surgical clipping varies from 2–49% in different surgical series [1,2,3,4,5, 7, 9, 12, 13, 15, 20, 24, 25, 27, 28, 31, 32]. No standards have been established for follow-up (FU) in cases with residual aneurysms after clipping. David et al and Raymond et al classified aneurysm remnants into 2 categories: “dog-ear” and “broad-based” residuals. “Dog ears” consist of a small neck remnant between the parent vessel and the base of the clip, whereas the reconstructed parent vessel of “broad-based” remnants contains part of the aneurysm wall [9, 29]. These differences in morphology suggest different risks for regrowth and subsequent rebleeding. The follow-up periods and the decision for surgery should be made based on the estimated risk of rupture
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