Abstract

OBJECT: The outcomes of microsurgery of previously coiled aneurysms are poorly described and little is known about what factors predict poor outcome. Therefore, we set out studying our case series to identify predictors of poor outcome following microsurgery for previously coiled recurrent aneurysms. METHODS: A retrospective cohort study from a prospectively maintained vascular database reviewing presentations, recurrent aneurysms measurements, surgery and outcomes of microsurgical clipping of recurrent previously coiled intracranial aneurysms. RESULTS: 39 patients (mean age 49 years, range 22-70 years) underwent microsurgical clipping of 40 previously coiled intracranial aneurysms. One patient suffered seizures, one transient neurological worsening and one hyponatraemia, none of whom had long-term sequelae. Two patients suffered postoperative infarcts giving an overall incidence of permanent morbidity of 5.1%. There were no deaths or rebleeds on follow up. In three patients, an attempt was made to remove the coil ball. These included the two patients with infarct and one with transient deficit. These patients had larger aneurysms (1106mm3 vs 135 mm3, p=0.005), with larger coil balls (257 mm3 vs 52 mm3, p=0.01) and wider necks (7.09 mm vs 2.69 mm, p=0.02) but smaller remnant heights (1.59mm vs 1.99mm, p=0.04). They were also more likely to have prolapsing coil loops (3/3 vs 3/27, p=0.016). CONCLUSIONS: Our study demonstrates good clinical outcomes from microsurgical clipping of recurrent aneurysms. In the vast majority of cases, clips can be applied primarily. Coil ball removal was associated with increased morbidity and should only be considered as a second line option and its likely need identified before surgery.