A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation

Mason A. Brown, Jonathan Parish, Cristian F. Guandique, Troy D. Payner, Terry Horner, Thomas Leipzig, Karishma V. Rupani, Richard Kim, Bradley N. Bohnstedt, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: With the recent evolution of endovascular therapies, objective evaluation of the efficacy of clip ligation for cerebral aneurysms should be performed. This study was undertaken to evaluate the durability of microsurgical clip ligation, identify risk factors for recurrence, and assess the need for long-term follow-up imaging. METHODS: A retrospective review of medical records identified 616 consecutive patients (156 male and 460 female patients; mean age 48.4 ± 12.4 years; range 6-90 years) who underwent microsurgical clip ligation and follow-up imaging at least 1 year after discharge between 1990 and 2010 at our institution. Of a total of 926 aneurysms in 616 patients, 758 aneurysms were microsurgically clip-ligated. At presentation, 431 of these aneurysms were ruptured and 327 aneurysms were unruptured. All patients underwent postoperative baseline imaging within the 1st month of their operation. A logistic regression analysis was performed to identify which variables are more likely to predict recurrence. RESULTS: Late follow-up angiographic imaging was obtained at a mean of 7.2 ± 4.7 years postdischarge (median 5.7 years; range 1-23 years). Of the 699 clipped aneurysms without residua, late follow-up angiography revealed only 1 (0.14%) recurrent aneurysm. Of the 59 residual aneurysms that remained after initial clip ligation on early postoperative imaging, 8 (13.6%) demonstrated growth. All of these aneurysms required treatment. None of the recurrences were due to broken or delayed displacement of clips. A total of 111 patients presented with multiple aneurysms. De novo aneurysm formation occurred in 8 (0.97%) patients, all of whom initially presented with multiple aneurysms. CONCLUSIONS: This study provides additional evidence to support the long-term efficacy of aneurysm clip ligation. The chance of aneurysm recurrence after complete clip ligation is very small. However, there is a regrowth risk of 1.83% per year for aneurysm remnants after incomplete clip ligation. These findings support the necessity for continued followup, late angiographic imaging, and the potential need for further intervention of incompletely ligated aneurysms. Furthermore, completely clip-ligated aneurysms may not require additional surveillance imaging unless multiple aneurysms were evident at presentation.

Original languageEnglish (US)
Pages (from-to)819-824
Number of pages6
JournalJournal of Neurosurgery
Volume126
Issue number3
DOIs
StatePublished - Mar 1 2017

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Surgical Instruments
Aneurysm
Ligation
Recurrence
Ruptured Aneurysm
Intracranial Aneurysm
Medical Records
Angiography

Keywords

  • Aneurysm
  • Angiography
  • Clip ligation
  • Follow-up
  • Recurrence
  • Subarachnoid hemorrhage
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation. / Brown, Mason A.; Parish, Jonathan; Guandique, Cristian F.; Payner, Troy D.; Horner, Terry; Leipzig, Thomas; Rupani, Karishma V.; Kim, Richard; Bohnstedt, Bradley N.; Cohen-Gadol, Aaron.

In: Journal of Neurosurgery, Vol. 126, No. 3, 01.03.2017, p. 819-824.

Research output: Contribution to journalArticle

Brown, MA, Parish, J, Guandique, CF, Payner, TD, Horner, T, Leipzig, T, Rupani, KV, Kim, R, Bohnstedt, BN & Cohen-Gadol, A 2017, 'A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation', Journal of Neurosurgery, vol. 126, no. 3, pp. 819-824. https://doi.org/10.3171/2016.2.JNS152059
Brown, Mason A. ; Parish, Jonathan ; Guandique, Cristian F. ; Payner, Troy D. ; Horner, Terry ; Leipzig, Thomas ; Rupani, Karishma V. ; Kim, Richard ; Bohnstedt, Bradley N. ; Cohen-Gadol, Aaron. / A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation. In: Journal of Neurosurgery. 2017 ; Vol. 126, No. 3. pp. 819-824.
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abstract = "OBJECTIVE: With the recent evolution of endovascular therapies, objective evaluation of the efficacy of clip ligation for cerebral aneurysms should be performed. This study was undertaken to evaluate the durability of microsurgical clip ligation, identify risk factors for recurrence, and assess the need for long-term follow-up imaging. METHODS: A retrospective review of medical records identified 616 consecutive patients (156 male and 460 female patients; mean age 48.4 ± 12.4 years; range 6-90 years) who underwent microsurgical clip ligation and follow-up imaging at least 1 year after discharge between 1990 and 2010 at our institution. Of a total of 926 aneurysms in 616 patients, 758 aneurysms were microsurgically clip-ligated. At presentation, 431 of these aneurysms were ruptured and 327 aneurysms were unruptured. All patients underwent postoperative baseline imaging within the 1st month of their operation. A logistic regression analysis was performed to identify which variables are more likely to predict recurrence. RESULTS: Late follow-up angiographic imaging was obtained at a mean of 7.2 ± 4.7 years postdischarge (median 5.7 years; range 1-23 years). Of the 699 clipped aneurysms without residua, late follow-up angiography revealed only 1 (0.14{\%}) recurrent aneurysm. Of the 59 residual aneurysms that remained after initial clip ligation on early postoperative imaging, 8 (13.6{\%}) demonstrated growth. All of these aneurysms required treatment. None of the recurrences were due to broken or delayed displacement of clips. A total of 111 patients presented with multiple aneurysms. De novo aneurysm formation occurred in 8 (0.97{\%}) patients, all of whom initially presented with multiple aneurysms. CONCLUSIONS: This study provides additional evidence to support the long-term efficacy of aneurysm clip ligation. The chance of aneurysm recurrence after complete clip ligation is very small. However, there is a regrowth risk of 1.83{\%} per year for aneurysm remnants after incomplete clip ligation. These findings support the necessity for continued followup, late angiographic imaging, and the potential need for further intervention of incompletely ligated aneurysms. Furthermore, completely clip-ligated aneurysms may not require additional surveillance imaging unless multiple aneurysms were evident at presentation.",
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AU - Horner, Terry

AU - Leipzig, Thomas

AU - Rupani, Karishma V.

AU - Kim, Richard

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N2 - OBJECTIVE: With the recent evolution of endovascular therapies, objective evaluation of the efficacy of clip ligation for cerebral aneurysms should be performed. This study was undertaken to evaluate the durability of microsurgical clip ligation, identify risk factors for recurrence, and assess the need for long-term follow-up imaging. METHODS: A retrospective review of medical records identified 616 consecutive patients (156 male and 460 female patients; mean age 48.4 ± 12.4 years; range 6-90 years) who underwent microsurgical clip ligation and follow-up imaging at least 1 year after discharge between 1990 and 2010 at our institution. Of a total of 926 aneurysms in 616 patients, 758 aneurysms were microsurgically clip-ligated. At presentation, 431 of these aneurysms were ruptured and 327 aneurysms were unruptured. All patients underwent postoperative baseline imaging within the 1st month of their operation. A logistic regression analysis was performed to identify which variables are more likely to predict recurrence. RESULTS: Late follow-up angiographic imaging was obtained at a mean of 7.2 ± 4.7 years postdischarge (median 5.7 years; range 1-23 years). Of the 699 clipped aneurysms without residua, late follow-up angiography revealed only 1 (0.14%) recurrent aneurysm. Of the 59 residual aneurysms that remained after initial clip ligation on early postoperative imaging, 8 (13.6%) demonstrated growth. All of these aneurysms required treatment. None of the recurrences were due to broken or delayed displacement of clips. A total of 111 patients presented with multiple aneurysms. De novo aneurysm formation occurred in 8 (0.97%) patients, all of whom initially presented with multiple aneurysms. CONCLUSIONS: This study provides additional evidence to support the long-term efficacy of aneurysm clip ligation. The chance of aneurysm recurrence after complete clip ligation is very small. However, there is a regrowth risk of 1.83% per year for aneurysm remnants after incomplete clip ligation. These findings support the necessity for continued followup, late angiographic imaging, and the potential need for further intervention of incompletely ligated aneurysms. Furthermore, completely clip-ligated aneurysms may not require additional surveillance imaging unless multiple aneurysms were evident at presentation.

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