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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
Kim, Pius (Department of Neurosurgery, College of Medicine, Chosun University) Jang, Suk Jung (Department of Neurosurgery, College of Medicine, Chosun University)
저널정보
대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제61권 제2호
발행연도
2018.1
수록면
212 - 218 (7page)

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Objective : Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. Methods : From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively. Detailed case-by-case analysis was performed based on preoperative, postoperative and follow-up radiologic examinations and operative findings. All clinical variables including age, sex, aneurysm size and location, type and number of applied clips, prognosis, and time to recurrence are evaluated. All patients are classified by causes of the recurrence. Possible risk factors that could contribute to those causes and overcoming ways are comprehensively discussed. Results : All recurrent aneurysms after surgical clipping were 14 of 2364 (0.5%). Three cases were males and 11 cases were females. Mean age was 52.3. At first treatment, nine cases were ruptured aneurysms, four cases were unruptured aneurysms, and one case was unknown. Locations of recurrent aneurysm were determined; anterior communicating artery (A-com) (n=7), posterior communicating artery (P-com) (n=3), middle cerebral artery (n=2), anterior cerebral artery (n=1) and basilar artery (n=1). As treatment of the recurrence, 11 cases were treated by surgical clipping and three cases were treated by endovascular coil embolization. Three cases of all 14 cases occurred in a month after the initial treatment. Eleven cases occurred after a longer interval, and three of them occurred after 15 years. By analyzing radiographs and operative findings, several main causes of the recurrent cerebral aneurysm were found. One case was incomplete clipping, five cases were clip slippage, and eight cases were fragility of vessel wall near the clip edge. Conclusion : This study revealed main causes of the recurrent aneurysm and contributing risk factors to be controlled. To manage those risk factors and ultimately prevent the recurrent aneurysm, neurosurgeons have to be careful in the technical aspect during surgery for a complete clipping without a slippage. Even in a perfect surgery, an aneurysm may recur at the clip site due to a hemodynamic change over years. Therefore, all patients must be followed up by imaging for a long period of time.
#Recurrence #Aneurysm #Clips

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참고문헌 (18)

참고문헌 신청
Soon-Seob Ahn / 2010 / Three-Dimensional Digital Subtraction Angiographic Evaluation of Aneurysm Remnants after Clip Placement / 대한신경외과학회지 47(3):185~190 google schola Dandy WE / 1938 / Intracranial aneurysm of the internal carotid artery: cured by operation / Ann Surg 107:654~659 Crossref Elijovich L / 2008 / Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study / Stroke 39:1501~1506 Crossref 임은현 / 2010 / Characteristics and Management of Residual or Slowly Recurred Intracranial Aneurysms / 대한신경외과학회지 48(4):330~334 google schola Inagawa T / 1988 / Aneurysmal subarachnoid hemorrhage in izumo city and shimane prefecture of Japan. Incidence / Stroke 19:170~175 Crossref

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