MICROSURGICAL MANAGEMENT OF RECURRENT INTRACRANIAL ANEURYSMS FOLLOWING ENDOVASCULAR TREATMENT: A SINGLE INSTITUTION ILLUSTRATIVE CASE SERIES AND LITERATURE REVIEW.

Microsurgical clipping and endovascular coiling are both effective management modalities for intracranial aneurysms, whereas recent procedures are mainly directed towards endovascular treatment because of its minimally invasive nature. However, such a treatment has been associated with a bigger risk of recurrent aneurysmal growth and re-bleeding urging a selection of optimal strategies to overcome these hazards. It seems that the most appropriate method of choice is microsurgical clipping, which is much more technically challenging due to recurrent aneurysm demanding configuration created by the initial coiling. Herein, we present an illustrative institutional case series of recurrent intracranial aneurysms following endovascular treatment, and discuss the controversies and benefits of their subsequent microsurgical management, based on our experience and on literature review. Considering the results reported in this paper, it seems that careful selective microsurgical neck clipping with/without aneurysmal sac resection and coil extraction remains the preferred management option for recurrent intracranial aneurysms, resulting in high obliteration rates, long-term occlusion stability, and low morbidity/mortality. In conclusion, to bring a satisfactory outcome, the multidisciplinary management of recurrent intracranial aneurysms after endovascular treatment should be adjusted to aneurysm morphology/size/location, and individualized according to patient needs.