REOPERATIVE MANAGEMENT OF INTRACRANIAL ANEURYSMS

Nineteen patients underwent 20 operative procedures for the treatment of recurrent or residual aneurysms. There were 13 small, three large, and four giant lesions; with one exception, all were in the anterior c irculation. Five individuals presented with recurrent subarachnoid hem orrhage, six were referred for symptoms of mass effect, and nine were known to have had inadequate treatment at the time of the initial oper ative procedure. The average time interval from initial treatment to e ither recurrent subarachnoid hemorrhage or compressive effects: was 10 .5 and 9.75 years, respectively. No deaths resulted from the reoperati ve procedures. Two patients suffered moderate disability and one had s evere disability. Malpositioned or slipped clips, intraoperative ruptu re, and inadequate exposure were responsible for 75% of the initial op erative failures. The technical difficulty of the reoperative procedur e correlated with the length of time between initial and reoperative t reatment, the presence of clips and coating agents, and the complexity of the lesion. A classification scheme for preoperative planning and case selection is proposed based on the technical adjuncts required fo r reoperative aneurysm procedures.