Objectives: The goal of the aneurysm surgery is complete circulatory exclusion of the aneurysm without compromise of the normal vessels. Failure to obliterate intracranial aneurysm completely during initial surgery still occurs in spite of recent technical advances.
Methods and Materials: Between 1980 and November, 18th 2002, we have performed 2,500 cases aneurysm surgery. Among these, we experienced 29 reoperated cases for the failed initial aneurysm surgery, including 7 intraoperative clip readjustment after intra-operative angiography.
Results: Twenty-nine cases were reoperated for the failed surgery. Of them, 7 cases were performed intraoperative angiography and the others(22) were not. 3 cases were performed initial operation in other hospital. The number of location of aneurysm was 15 A-com, 7 ICA and 5 MCA. tec. The causes of operations were vessel occlusion(8), residual neck(7), rebleeding after coating(5), aneurismal filling(3), slipped clip(2) and others. Clinical outcomes were better than in readjustment group after intraoperative angiography; above favorable outcome in 6(85.7%), but 16(72.7%) in group without intraoperative angiography.
Conclusion: Reoperative management for failed aneurysm surgery is very difficult because of scar tissue, coating material and previously placed clip etc. Preoperative and postoperative detailed radiological and clinical assessment should be performed to determine the success of surgical treatment. During operative procedure, the use of intraoperative angiography, endoscopy and doppler sonography etc. will reduce the need of another operation and decrease the risk of post operative complications.
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