Abstract
Nine cases of ruptured cerebral aneurysms with imperfect neck clipping are reported, and their clinical characteristics including problems in the initial operation are discussed. The patients included six women and three men, with a mean age of 54 years, all of whom had neck clipping as an initial treatment within three months after their most recent subarachnoid hemorrhage. Three of the patients had the aneurysms on the anterior communicating arteries and four on the carotid communicating and vertebrobasilar arteries. The aneurysms were small (12mm or less in diameter) on the angiogram in five of the nine patients. There was no case of giant aneurysm. Eight of the nine patients had rebleeding, and one showed regrowth of the aneurysm on the serial angiogram after the operation. Rebleeding occurred within 14 days in six of the eight patients. The outcome of the patients was unfavorable, with a mortality rate of 66.7%. Three of the four patients undergoing reoperation, however, showed good or fair outcomes. The reasons for imperfect clip placement at the initial operation were incomplete dissection of the aneurysmal neck in four patients, fear of kinking or occlusion of the parent vessels in three, and premature or slipped clip in two. These facts emphasize the importance of confirming perfect clip placement during surgery. If doubt exists, reoperation should be considered as early as possible within two weeks after the initial operation following immediate postoperative angiography.
