Residual aneurysm neck [Neurosurgery Wiki]

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====== Residual aneurysm neck ======

see [[Modified Raymond-Roy Classification]]

see also [[Aneurysm recurrence]].
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Radiologically, a [[residual aneurysm]] [[neck]] is defined as a small segment at the base of the aneurysm proximal to a [[clip]] which still fills with contrast material on postoperative angiography.
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[[Residual aneurysm]] from [[incomplete aneurysm clipping]] or slowly [[recurrent aneurysm]] is associated with high risk of [[subarachnoid hemorrhage]]. 

===== Case series =====


Ihm et al. described complete treatment of the lesions by surgical [[clipping]] or [[endovascular treatment]].

They analyzed 11 patients of residual or recurrent aneurysms who had undergone surgical clipping from [[1998]] to [[2009]]. Among them, 5 cases were initially clipped at the author hospital. The others were referred from other hospitals after clipping. The radiologic and medical records were retrospectively analyzed.

All patients presented with subarachnoid hemorrhage at first time, and the most frequent location of the ruptured residual or recurrent aneurysm was in the anterior communicating artery to posterior-superior direction. Distal anterior cerebral artery, posterior communicating artery, and middle cerebral artery was followed. Repositioning of clipping in eleven cases, and one endovascular treatment were performed. No residual aneurysm was found in postoperative angiography, and no complication was noted in related to the operations.

These results indicate the importance of postoperative or follow up angiography and that [[reoperation]] of residual or slowly recurrent aneurysm should be tried if such lesions being found. Precise evaluation and appropriate planning including [[endovascular treatment]] should be performed for complete obliteration of the residual or recurrent aneurysm
((Ihm EH, Hong CK, Shim YS, Jung JY, Joo JY, Park SW. Characteristics and management of residual or slowly recurred intracranial aneurysms. J Korean Neurosurg Soc. 2010 Oct;48(4):330-4. doi: 10.3340/jkns.2010.48.4.330. Epub 2010 Oct 30. PMID: 21113360; PMCID: PMC2982911.)).
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Patients treated in whom a large portion of the [[aneurysm neck]] or [[aneurysm sac]] remained after application of a [[clip]] or [[ligature]] have been subjected to [[reoperation]]. However, 1- to 2-mm residual necks seen in postoperative angiography have been thought to pose little risk. Some cases of [[aneurysm]]s recurring from a narrow residual neck after [[clipping]] have been reported, and a few instances of recurrent aneurysm have been described after apparently complete [[occlusion]] of the neck (as observed angiographically or in the surgeon's judgment). In recent years, a surprising number of cases have been presented in which this seemingly unimportant remnant of the neck dilated over a long period to become a dangerous aneurysm. This finding stresses the importance of complete aneurysm [[occlusion]] and of postoperative angiography for the recognition of a residual aneurysm neck. This should be important not only in aneurysm clipping but also in the endovascular treatment of intracranial aneurysms with detachable balloons
((Lin T, Fox AJ, Drake CG. Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg. 1989 Apr;70(4):556-60. doi: 10.3171/jns.1989.70.4.0556. PMID: 2926496.)).