Technical Difficulty of Reoperation of Aneurysmal Rebleeding Long-term After the First Clipping

Abstract

In this paper we report on two cases of recurrent subarachnoid hemorrhage nine and ten years after the first surgery, in which complete reclipping was performed. Case 1 had a right ICPC aneurysm with a fractured Heifetz clip, and Case 2 had a left ophthalmic aneurysm with a slipped Scoville clip.
In reoperating long after the first operation, scarring makes the approach, exposure and reclipping more difficult than in the first operation or early reoperation. Plastic adhesive such as Biobond or cyanoacrylate and various materials used for wrapping make scar formation harder and more severe. Sometimes coating or wrapping added to the clipping is incomplete, ineffective and dangerous.
The need for angiography during the surgery to ensure complete clipping is emphasized.