クリッピング後再発脳動脈瘤の手術  [in Japanese] Surgery of Recurrent Intracranial Aneurysms after Neck Clipping  [in Japanese]

We report, our experience in surgical clipping of 7 patients with a recurrent intracranial ancurysm previously treated by neck clipping. All were treated under deliberate mild hypothermia for protection from ischemia during intraoperative temporary vessel occlusion. Surgical approaches were the same as previous in 5, extended in 1 and different in the 7th, which made it possible to expose the entire length of the previous clip. Intraoperative temporary vessel occlusion was necessary in 5 cases and the maximum occlusion time of each case was 7 to 15 minutes. Clipping was successfully completed without surgical complications in all but 1 case, which suffered transient mild hemiparesis with small infarction in the territory of the perforating artery due to intraoperative temporary vessel occlusion. Adequate selection of surgical approach and sharp dissection around the aneurysm were essential. We emphasize the usefulness of intraoperative mild hypothermia for protection from ischemic insults during temporary vessel occlusion in territory supplied with the cortical artery.