Regrowth of aneurysm sacs from residual neck following aneurysm clipping

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  • 1 Departments of Diagnostic Radiology (Neuroradiology) and Clinical Neurological Sciences (Neuroradiology, Neurosurgery), University Hospital, University of Western Ontario, London, Ontario, Canada
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✓ It is recognized that incomplet treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences. For this reason, patients treated at the authors' institution in whom a large portion of the aneurysm neck or sac remained after application of a clip or ligature have been subjected to reoperation. However, 1- to 2-mm residual necks seen in postoperative angiography have been thought to pose little risk. Some cases of aneurysms recurring from a narrow residual neck after clipping have been reported, and a few instances of recurrent aneurysm have been described after apparently complete occlusion of the neck (as observed angiographically or in the surgeon's judgment). In recent years, a surprising number of cases have been presented in which this seemingly unimportant remnant of the neck dilated over a long period to become a dangerous aneurysm. This finding stresses the importance of complete aneurysm occlusion and of postoperative angiography for the recognition of a residual aneurysm neck. This should be important not only in aneurysm clipping but also in the endovascular treatment of intracranial aneurysms with detachable balloons.

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Contributor Notes

Address reprint requests to: Allan J. Fox, M.D., Radiology Department, University Hospital, 339 Windermere Road, London, Ontario N6A 5A5, Canada.

Present address for Dr. Lin: Centro de Diagnostico Computado, Sanatorio Largherio, Montevideo, Uruguay.

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