Abstract
Microsurgical clip ligation is considered a definitive treatment for intracranial
aneurysms (IAs), resulting in low rates of local recurrence that range from 0.2 to
0.5% and a latency period that averages about a decade. Our case report describes
an early asymptomatic recurrence (i.e., without sentinel headache or seizure) less
than 1 year after this 20-year-old woman underwent clip ligation of a ruptured anterior
communicating artery (AComA) aneurysm. At recurrence, the patient underwent coiling
of the regrowth; follow-up imaging at 6 and 18 months demonstrated complete IA occlusion.
To review the putative risk factors of this rare phenomenon, the authors searched
the PubMed database using the keywords “intracranial aneurysm,” “recurrence,” and
“clipping” in various combinations. In the seven cases identified, all occurred in
initially ruptured IA, which was often at the AComA, and six of seven patients were
younger than 50 years old. Although most IA remnants grow slowly, early recurrence
may represent a more aggressive biological behavior that warrants special attention
in younger patients, positive rupture status, and unintended remnant of any size.
In such a constellation, early imaging follow-up within the first 6 months may be
warranted to rule out early IA recurrence
Keywords
intracranial aneurysm - clipping - aneurysm recurrence - subarachnoid hemorrhage
