Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan.
Oper Neurosurg (Hagerstown). 2017 Dec 1;13(6):670-678. doi: 10.1093/ons/opx033.
Recurrent aneurysms after initial clipping have been discussed as an important issue in the surgical management of aneurysm.
To report our experience with recurrent cerebral aneurysms after neck clipping and to discuss classification and recommended management.
Aneurysm treatments from a single institution over a 20-year period were retrospectively reviewed. Twenty-three recurrent aneurysms in 23 patients were managed during the study period. Recurrent aneurysms were classified using the concepts of closure line and closure plane, as follows. Type 1: neck situated in an almost different site from the previous clip. Type 2: existing closure plane and reconstructive closure plane are almost the same. Type 3: existing closure plane and reconstructive closure plane cross (type 3a); in rare cases, the existing closure line is sufficiently distant from the neck (type 3b). Type 4: no reconstructive closure line is identifiable.
Nine patients presented with subarachnoid hemorrhage at recurrence. The mean interval to recurrence was 15.0 years. Management comprised clipping with elective subsequent old-clip removal (n = 7), clipping with preceding old-clip removal (n = 2), bypass occlusion (n = 1), coating (n = 1), combined surgery (n = 1), endovascular surgery (n = 4), and observation (n = 3). Therapeutic intervention was not indicated in 4 patients. Types 3a and 4 required more complex surgical procedures or coil embolization. Procedural complications were observed in 2 patients.
A small but definite propensity toward recurrence after neck clipping exists, and most recurrent aneurysms require some form of retreatment. The novel classification scheme may provide conceptual clarity and therapeutic guidance for decision making.
初次夹闭后复发的动脉瘤一直是动脉瘤外科治疗中的一个重要问题。
报告我们在颈夹闭后复发性脑动脉瘤治疗方面的经验，并讨论分类和推荐的治疗方法。
回顾性分析了一家单机构 20 年来的动脉瘤治疗情况。在研究期间，共对 23 例 23 名患者的 23 个复发性动脉瘤进行了治疗。根据闭合线和闭合面的概念对复发性动脉瘤进行分类，如下：1 型：颈位于与前次夹闭几乎不同的部位；2 型：现有的闭合面和重建闭合面几乎相同；3 型：现有的闭合面和重建闭合面交叉（3a 型）；在极少数情况下，现有的闭合线与颈根部足够远（3b 型）；4 型：无法识别重建闭合线。
9 例患者在复发时出现蛛网膜下腔出血。复发的平均间隔时间为 15.0 年。治疗方法包括夹闭并选择性随后移除旧夹（n = 7）、夹闭前移除旧夹（n = 2）、旁路闭塞（n = 1）、涂层（n = 1）、联合手术（n = 1）、血管内手术（n = 4）和观察（n = 3）。4 例患者未进行治疗性干预。3a 型和 4 型需要更复杂的手术或线圈栓塞。2 例患者出现手术并发症。
颈夹闭后确实存在较小但明确的复发倾向，大多数复发性动脉瘤需要某种形式的再治疗。新的分类方案可为决策提供概念上的清晰性和治疗指导。
