Introduction: Intracranial aneurysms are the one of most complicated conditions confronted by a neurosurgeon. Even though endovascular procedure is preferred, open surgery and clipping of the aneurysm still remains gold standard procedure for many aneurysms. Proximal control of the parent vessel remains one of the most critical steps in clipping the aneurysms and this can be achieved by various ways such as temporary clipping and transient cardiac standstill using adenosine. Temporary clipping is associated with complications such as infarct and injury to the vessel, whereas temporary hypotension using adenosine provides a way for successful clipping of the aneurysm. Here, we present our experience with adenosine in patients undergoing clipping of aneurysms in our institution between 2017 and 2020. Methodology: It is a retrospective cohort study conducted on patients undergoing craniotomy and clipping of aneurysms and in those where adenosine is not contraindicated. Patients are divided into Group A where adenosine is not used and Group B where adenosine is used. Results: In Group B, where adenosine is used, clipping was easier, with less incidence of intraoperative ruptures, less usage of Temporary clip (TC) and less incidence of infarct, reduce clipping time with no side effects. Conclusion: Adenosine-induced transient cardiac arrest and hypotension are a safe and effective method in facilitating aneurysm clipping.
{"title":"Adenosine in facilitating aneurysm clipping: An institutional experience","authors":"G. Manoharan, R. Prasad, Senthil Kumar, K. Arvind","doi":"10.4103/jcvs.jcvs_3_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_3_22","url":null,"abstract":"Introduction: Intracranial aneurysms are the one of most complicated conditions confronted by a neurosurgeon. Even though endovascular procedure is preferred, open surgery and clipping of the aneurysm still remains gold standard procedure for many aneurysms. Proximal control of the parent vessel remains one of the most critical steps in clipping the aneurysms and this can be achieved by various ways such as temporary clipping and transient cardiac standstill using adenosine. Temporary clipping is associated with complications such as infarct and injury to the vessel, whereas temporary hypotension using adenosine provides a way for successful clipping of the aneurysm. Here, we present our experience with adenosine in patients undergoing clipping of aneurysms in our institution between 2017 and 2020. Methodology: It is a retrospective cohort study conducted on patients undergoing craniotomy and clipping of aneurysms and in those where adenosine is not contraindicated. Patients are divided into Group A where adenosine is not used and Group B where adenosine is used. Results: In Group B, where adenosine is used, clipping was easier, with less incidence of intraoperative ruptures, less usage of Temporary clip (TC) and less incidence of infarct, reduce clipping time with no side effects. Conclusion: Adenosine-induced transient cardiac arrest and hypotension are a safe and effective method in facilitating aneurysm clipping.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116857465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Trigeminal neuralgia is one of the most common facial pain syndromes. Although there are many postulated hypotheses explaining the pain, microvascular compression of the root entry zone (REZ) of the trigeminal nerve is commonly accepted to be the pathology for neuralgia. Various medical and surgical treatments are available to relieve the pain and microvascular decompression of the trigeminal nerve at the REZ is considered as the most successful modality and the gold standard. Methods: In this video atlas on operative nuances, we have described nine common scenarios that could be encountered during this surgery. Conclusion: Thorough knowledge of the different intraoperative scenarios is crucial for a complete microvascular decompression that translates into a good post-operative outcome.
{"title":"A concise operative atlas of microvascular decompression – Different intraoperative scenarios and technical nuances","authors":"Roopesh Kumar, A. Karthikayan","doi":"10.4103/jcvs.jcvs_21_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_21_21","url":null,"abstract":"Background: Trigeminal neuralgia is one of the most common facial pain syndromes. Although there are many postulated hypotheses explaining the pain, microvascular compression of the root entry zone (REZ) of the trigeminal nerve is commonly accepted to be the pathology for neuralgia. Various medical and surgical treatments are available to relieve the pain and microvascular decompression of the trigeminal nerve at the REZ is considered as the most successful modality and the gold standard. Methods: In this video atlas on operative nuances, we have described nine common scenarios that could be encountered during this surgery. Conclusion: Thorough knowledge of the different intraoperative scenarios is crucial for a complete microvascular decompression that translates into a good post-operative outcome.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121098121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amit Sharma, Ruhi Mamualiya, Rahul Inganal, Daljit Singh, B. Mahajan
Introduction: The inflammatory events are implicated in the pathophysiology of subarachnoid haemorrhage (SAH) and secondary brain injury. The goal of this study was to determine the role of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) as an early predictor of the poor neurological outcome at 6 months in individuals with SAH. Methods: In this prospective, observational study of consecutive patients with aneurysmal SAH included over 1 year. Peak IL-6 and hsCRP were used as an indicator of the inflammatory response. Initial IL-6 and hs-CRP levels were collected within 12 h from admission and then for the next consecutive 7 days. The primary outcome was neurological status at 6-month follow-up assessed with the Modified Rankin Scale (0–6) with a score with or higher than 3 labelled as poor outcome. Logistic regression analyses were used to evaluate the associations between the peak serum IL-6 and hs-CRP levels and the neurological outcome. Results: The median peak levels of both markers were significantly higher in the poor outcome group on all 7 days. A significant correlation was seen between peak IL-6 and poor Hunt and Hess grade (P = 0.006), infarction (0.033) and systemic infection (0.03), whereas peak hsCRP had a correlation with rebleed (P = 0.017) and clipping (P = 0.032). Significant risk factors for the poor outcome were poor Hunt and Hess grade (P < 0.000) and high Fisher grades (P = 0.021) and peak IL-6 levels (P = 0.014) on regression analysis. Conclusion: The serial measurements of inflammatory markers IL-6 and hsCRP may be used to predict the neurological outcome in aSAH patients. The peak IL-6 levels correlated significantly with poor neurological outcome. Although hsCRP was elevated in patients with the poor outcome, it was statistically non-significant, suggesting a non-specific inflammatory stress response.
{"title":"Clinical Significance of Serial Measurements of Interleukin-6 and High-Sensitivity C-Reactive Protein as Early Predictor of Poor Neurological Outcome in Aneurysmal Subarachnoid Haemorrhage","authors":"Amit Sharma, Ruhi Mamualiya, Rahul Inganal, Daljit Singh, B. Mahajan","doi":"10.4103/jcvs.jcvs_4_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_4_22","url":null,"abstract":"Introduction: The inflammatory events are implicated in the pathophysiology of subarachnoid haemorrhage (SAH) and secondary brain injury. The goal of this study was to determine the role of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) as an early predictor of the poor neurological outcome at 6 months in individuals with SAH. Methods: In this prospective, observational study of consecutive patients with aneurysmal SAH included over 1 year. Peak IL-6 and hsCRP were used as an indicator of the inflammatory response. Initial IL-6 and hs-CRP levels were collected within 12 h from admission and then for the next consecutive 7 days. The primary outcome was neurological status at 6-month follow-up assessed with the Modified Rankin Scale (0–6) with a score with or higher than 3 labelled as poor outcome. Logistic regression analyses were used to evaluate the associations between the peak serum IL-6 and hs-CRP levels and the neurological outcome. Results: The median peak levels of both markers were significantly higher in the poor outcome group on all 7 days. A significant correlation was seen between peak IL-6 and poor Hunt and Hess grade (P = 0.006), infarction (0.033) and systemic infection (0.03), whereas peak hsCRP had a correlation with rebleed (P = 0.017) and clipping (P = 0.032). Significant risk factors for the poor outcome were poor Hunt and Hess grade (P < 0.000) and high Fisher grades (P = 0.021) and peak IL-6 levels (P = 0.014) on regression analysis. Conclusion: The serial measurements of inflammatory markers IL-6 and hsCRP may be used to predict the neurological outcome in aSAH patients. The peak IL-6 levels correlated significantly with poor neurological outcome. Although hsCRP was elevated in patients with the poor outcome, it was statistically non-significant, suggesting a non-specific inflammatory stress response.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122748796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Posterior cerebral aneurysms are rare posterior circulation aneurysms. Clinical presentation can be varied from life-threatening subarachnoid hemorrhage to mass effect on adjacent structures. Due to their complex anatomical location, microsurgical clipping is not without challenges. Several approaches have been described based on the location of the aneurysm in relation to the segment of the posterior cerebral artery (PCA). We describe a combined approach for surgical clipping of a postcommunicating anterior segment PCA aneurysm.
{"title":"Combined Sub-temporal and Pterional Exposure for Clipping of Posterior Cerebral Artery Aneurysm","authors":"G. Menon, A. Varsha, Vinod Kumar, Ajay Hegde","doi":"10.4103/jcvs.jcvs_1_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_1_22","url":null,"abstract":"Posterior cerebral aneurysms are rare posterior circulation aneurysms. Clinical presentation can be varied from life-threatening subarachnoid hemorrhage to mass effect on adjacent structures. Due to their complex anatomical location, microsurgical clipping is not without challenges. Several approaches have been described based on the location of the aneurysm in relation to the segment of the posterior cerebral artery (PCA). We describe a combined approach for surgical clipping of a postcommunicating anterior segment PCA aneurysm.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134461739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous thrombosis of giant intracranial aneurysm with parent artery occlusion is uncommon. We present an unusual case of a 28-year-old female who presented with a hemispheric infarct probably secondary to dissection of the cervical internal carotid artery (ICA). The cervical ICA occlusion simultaneously induced total thrombosis of pre-existing incidental giant cavernous ICA aneurysm. We discuss the various theories and probable mechanisms involved.
{"title":"Spontaneous thrombosis of internal carotid artery with occlusion of giant cavernous carotid aneurysm and malignant hemispheric infarct – Cure or curse?","authors":"G. Menon, A. Pradhan, Ajay Hegde","doi":"10.4103/jcvs.jcvs_23_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_23_21","url":null,"abstract":"Spontaneous thrombosis of giant intracranial aneurysm with parent artery occlusion is uncommon. We present an unusual case of a 28-year-old female who presented with a hemispheric infarct probably secondary to dissection of the cervical internal carotid artery (ICA). The cervical ICA occlusion simultaneously induced total thrombosis of pre-existing incidental giant cavernous ICA aneurysm. We discuss the various theories and probable mechanisms involved.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127661732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dural arteriovenous fistulas (DAVF) are rare acquired vascular malformations of the brain with varied clinical presentations based on the location and pattern of venous drainage. Aggressive management of DAVF is predominantly endovascular with open surgical obliteration reserved for a few selected cases. DAVF around the trocular herophili are challenging as we need to preserve the superficial and deep venous channels for the normal drain drainage. We describe a case of complex DAVF centered around torcula herophili and left transverse sinus with complete obliteration of left sigmoid sinus and stenosis of the left transverse sigmoid sinus. The DAVF had retrograde venous drainage through the superficial and deep venous sinuses, cortical veins, competing with normal venous drainage of the brain with significant venous hypertension and cognitive impairment. Our goal was complete obliteration of all the feeders with preservation of the venous sinuses and reduction of venous hypertension to achieve cognitive improvement. Endovascular embolisation by transarterial route was done with flow control on the venous side using dimethyl sulfoxide compatible balloon. We have described the technical challenges and strategy to achieve complete obliteration of all the feeders around the sinus, with preservation of torcula using balloon inflation. Venous system flow was restored to the normal pattern and anti-coagulated for 24 h. Endovascular embolisation is the mainstay treatment for DAVF. To achieve cure, strategising the approach and extent of obliteration based on anatomy and venous drainage pattern of the brain is essential. Torcular DAVF pose a specific challenge, at it is the confluence of the superficial and deep venous system. Transvenous Balloon-assisted embolisation is a safe and effective method to achieve complete obliteration of DAVF with preservation of the venous sinuses.
{"title":"Torcular herophili dural arteriovenous fistula of the brain – Balloon-assisted flow-controlled embolisation with venous sinus preservation","authors":"S. Paramasivam, Kannah Elangovan","doi":"10.4103/jcvs.jcvs_9_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_9_22","url":null,"abstract":"Dural arteriovenous fistulas (DAVF) are rare acquired vascular malformations of the brain with varied clinical presentations based on the location and pattern of venous drainage. Aggressive management of DAVF is predominantly endovascular with open surgical obliteration reserved for a few selected cases. DAVF around the trocular herophili are challenging as we need to preserve the superficial and deep venous channels for the normal drain drainage. We describe a case of complex DAVF centered around torcula herophili and left transverse sinus with complete obliteration of left sigmoid sinus and stenosis of the left transverse sigmoid sinus. The DAVF had retrograde venous drainage through the superficial and deep venous sinuses, cortical veins, competing with normal venous drainage of the brain with significant venous hypertension and cognitive impairment. Our goal was complete obliteration of all the feeders with preservation of the venous sinuses and reduction of venous hypertension to achieve cognitive improvement. Endovascular embolisation by transarterial route was done with flow control on the venous side using dimethyl sulfoxide compatible balloon. We have described the technical challenges and strategy to achieve complete obliteration of all the feeders around the sinus, with preservation of torcula using balloon inflation. Venous system flow was restored to the normal pattern and anti-coagulated for 24 h. Endovascular embolisation is the mainstay treatment for DAVF. To achieve cure, strategising the approach and extent of obliteration based on anatomy and venous drainage pattern of the brain is essential. Torcular DAVF pose a specific challenge, at it is the confluence of the superficial and deep venous system. Transvenous Balloon-assisted embolisation is a safe and effective method to achieve complete obliteration of DAVF with preservation of the venous sinuses.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114461302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Practicality of aneurysm clipping over coiling in semi-urban and rural India","authors":"J. Dil","doi":"10.4103/jcvs.jcvs_12_22","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_12_22","url":null,"abstract":"","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129602611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyperdense middle cerebral artery (MCA) sign is a well-recognised sign of stroke radiology. However, less often reported is the pseudo 'hyperdense MCA sign' that looks ominous and may confound the clinician into thinking that he is dealing with a case of ischaemic stroke. We report a 56-year-old male who nearly underwent thrombolysis due to this sign seen on initial computed tomography imaging and highlight the way to avoid this pitfall.
{"title":"Pseudo-hyperdense MCA sign: The value of comparing CT densities of vessels on both sides","authors":"P. Krishnan","doi":"10.4103/jcvs.jcvs_5_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_5_21","url":null,"abstract":"Hyperdense middle cerebral artery (MCA) sign is a well-recognised sign of stroke radiology. However, less often reported is the pseudo 'hyperdense MCA sign' that looks ominous and may confound the clinician into thinking that he is dealing with a case of ischaemic stroke. We report a 56-year-old male who nearly underwent thrombolysis due to this sign seen on initial computed tomography imaging and highlight the way to avoid this pitfall.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128095385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dural arteriovenous fistulas (DAVF) are abnormal connections between the feeding arteries and veins within the dural leaflets and constitute 10%–15% of all intracranial arteriovenous malformations. DAVF draining into sphenoparietal sinus is a rare pathologic entity that is fed by the middle meningeal artery and is associated with a history of prior trauma. We report a unique case of DAVF of sphenoparietal sinus that had developed spontaneously. Being giant in morphology, it had eroded into the orbit and presented with proptosis, chemosis and restriction of eye movement. Although the clinical findings pointed towards caroticocavernous fistula, the real pathomorphology was unveiled by the six-vessel catheter angiography with selective catheterisation of smaller feeding vessels. All the feeding vessels were meticulously mapped out, and the fistulous connection was vividly identified and subsequently obliterated using detachable coils and n-butyl cyanoacrylate.
{"title":"A giant spontaneous dural arteriovenous fistula of the spheno-parietal sinus clinically masquerading as carotico-cavernous fistula: A case report","authors":"D. Mahakul, Rahul Inganal, Daljit Singh","doi":"10.4103/jcvs.jcvs_9_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_9_21","url":null,"abstract":"Dural arteriovenous fistulas (DAVF) are abnormal connections between the feeding arteries and veins within the dural leaflets and constitute 10%–15% of all intracranial arteriovenous malformations. DAVF draining into sphenoparietal sinus is a rare pathologic entity that is fed by the middle meningeal artery and is associated with a history of prior trauma. We report a unique case of DAVF of sphenoparietal sinus that had developed spontaneously. Being giant in morphology, it had eroded into the orbit and presented with proptosis, chemosis and restriction of eye movement. Although the clinical findings pointed towards caroticocavernous fistula, the real pathomorphology was unveiled by the six-vessel catheter angiography with selective catheterisation of smaller feeding vessels. All the feeding vessels were meticulously mapped out, and the fistulous connection was vividly identified and subsequently obliterated using detachable coils and n-butyl cyanoacrylate.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":" 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133017188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aravind Sabesan, Y. Kato, T. Kawase, Yasuhiro Yamada, Riki Tanaka
Recurrence of an aneurysm is not frequently seen after microsurgical clipping. The exact incidence is varied among studies related to recurrent aneurysms from 0.02% to 0.52%. A 68-year-old male, diagnosed with unruptured left middle cerebral artery (MCA) aneurysm 8 years back, was treated by microsurgical clipping then. He was on periodic follow-up since. On yearly follow-up, in 2015, magnetic resonance imaging/magnetic resonance angiography showed small recurrent aneurysm. This was followed up with serial imaging, and the aneurysm slowly grew in size. 2 years after, he was found to have a recurrent aneurysm; in 2017, he was operated for the recurrent aneurysm with microsurgical clipping. Here, we report the technical difficulties and strategies to approach recurrent MCA aneurysm.
{"title":"Surgical nuances of clip reconstruction of recurrent middle cerebral artery aneurysms: A technical note","authors":"Aravind Sabesan, Y. Kato, T. Kawase, Yasuhiro Yamada, Riki Tanaka","doi":"10.4103/jcvs.jcvs_17_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_17_21","url":null,"abstract":"Recurrence of an aneurysm is not frequently seen after microsurgical clipping. The exact incidence is varied among studies related to recurrent aneurysms from 0.02% to 0.52%. A 68-year-old male, diagnosed with unruptured left middle cerebral artery (MCA) aneurysm 8 years back, was treated by microsurgical clipping then. He was on periodic follow-up since. On yearly follow-up, in 2015, magnetic resonance imaging/magnetic resonance angiography showed small recurrent aneurysm. This was followed up with serial imaging, and the aneurysm slowly grew in size. 2 years after, he was found to have a recurrent aneurysm; in 2017, he was operated for the recurrent aneurysm with microsurgical clipping. Here, we report the technical difficulties and strategies to approach recurrent MCA aneurysm.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130229724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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