Abstract
Microsurgical clipping remains a durable treatment for intracranial aneurysms. Despite the low rate of re-treatment, recurrence of subarachnoid hemorrhage is 3% within the first 10 years. This may be caused by rupture of a recurrent or residual aneurysm at the clip site or by rupture of another untreated aneurysm. We investigated the natural history of aneurysms treated with microsurgical clipping at our institution over a 10-year period. A secondary objective was to analyze our compliance rate with follow-up angiograms at three and 10 years and to investigate a role for less-invasive imaging modalities to manage microsurgical clipping patients. Ruptured and/or unruptured aneurysm patients treated with microsurgical clipping from 2000–2008 who had angiographic follow-up were included. Data were analyzed with respect to formation of de novo aneurysms, presence of residual aneurysm after clipping, and the rate of recurrence after complete clipping. There were 24 residual aneurysms (13%), two de novo aneurysms (1%) and one recurrent aneurysm (0.5%). The size of the aneurysm was significantly associated with having a residual aneurysm. Patient sex was also significantly associated with having a residual aneurysm. Compliance with angiographic follow-up occurred in 31% of patients treated with the majority only having one study at three years. Microsurgical clipping of aneurysms is durable with a low rate of recurrence and rebleeding. Residuals do not show angiographic progression and rarely require re-treatment. Compliance with angiographic follow-up is poor and this suggests that less invasive and expensive imaging modalities should be evaluated. Categories: Neurosurgery
Highlights
Microsurgical clipping remains a durable treatment modality for intracranial aneurysms
The purpose of this study was to investigate the natural history of aneurysms treated with microsurgical clipping at our institution over a 10-year period
Some residual aneurysms were detected on the immediate postoperative angiogram (13%), which is consistent with the rates from International Subarachnoid Aneurysm Trial (ISAT) [5]
Summary
Microsurgical clipping remains a durable treatment modality for intracranial aneurysms. The results from the International Subarachnoid Aneurysm Trial (ISAT) showed that 3.8% of clipped aneurysms required re-treatment compared with 17.4% of those treated with endovascular coiling. Despite the low rate of re-treatment, the incidence of recurrent subarachnoid hemorrhage (SAH) after clipping is 3% within the first 10 years after treatment [2]. Recurrent SAH may be caused by rupture of a recurrent or residual aneurysm at the clip site or by rupture of an untreated additional aneurysm. Rates of residual aneurysms after microsurgical clipping range from 5 to 12% [4,5] and are thought to be associated with larger size, ruptured aneurysms, and technically challenging locations, such as the anterior communicating artery. A postoperative suboptimal angiogram may not detect a residual aneurysm at the clip site
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