Background: Microsurgical aneurysm (MSA) clipping is considered as the standard therapy with
the endovascular coiling. Microsurgical clipping is considered superior to endovascular
in terms of the recurrence rate. The management of recurrent aneurysm following previous
microsurgical clipping is challenging. The management of recurrent aneurysm following
previous microsurgical clipping is challenging. This study aims to explore the management
of recurrent aneurysm of the anterior communicating artery (ACoM). Materials and Methods: This is a case series of three elder women who had a recurrence of ACoM aneurysm
after MSA clipping. All the three patients were operated with microsurgical clipping.
We studied the preoperative images of the first surgery of all the patients. The
detailed case-by-case analysis was performed based on preoperative, postoperative,
and follow-up radiologic examinations and operative findings. Results: All three patients who had a recurrence after MSA clipping of ACoM aneurysm and were
asymptomatic. At presentation, they were diagnosed at the postoperative imaging at
follow-up. The earliest recurrence was 1 year while in one patient; the recurrence
was detected 8 years after the initial MSA clipping. The cerebral aneurysms were posteriorly
directed in the initial preoperative images in all the cases. Conclusion: This study revealed the recurrence as the residual neck or the enlargement of the
aneurysm even after MSA in these cases of ACoM aneurysm. Even with the complete clipping,
there can be recurrence at the clip site due to the change in hemodynamics over the
time. We should follow-up the patients regularly even after microsurgical clipping.
Key-words:
Aneurysm - anterior communicating artery - management - microsurgical clipping - recurrence
