The case of recurrent aneurysm of the middle cerebral artery after reconstructive clipping (clinical case and literature review)

The improvement of methods of noninvasive radiation diagnostics, their wide accessibility to the population of developed countries, has made it indisputable that a recurrent course of aneurysmal brain disease is possible, even in cases of radical surgical treatment. The main causes of the progression of aneurysmal disease are considered to be an increase in the size of residual aneurysms, recurrence and formation of de novo aneurysms.

The article describes the case of successful treatment of a 43-year-old female patient with a recurrent aneurysm of the fork of the middle cerebral artery. The issues of dispensary observation of patients with cerebral aneurysms and surgical tactics in cases of progressive course of aneurysmal disease, which remains the subject of scientific discussions to date, are discussed.

Female patient with a ruptured aneurysm of the middle cerebral artery was admitted in serious condition. Reconstructive clipping was performed using 5 clips. Control angiography revealed a recurrence in the cervical part of a small size. After 5 years of stable angiographic picture, an increase in the cervical part was revealed. Repeated surgical treatment was performed – clipping of a recurrent middle cerebral artery aneurysm. In control cerebral angiography, the aneurysm is not contrasted.

The modern concept of treatment of aneurysmal brain disease involves the most radical shutdown of a ruptured aneurysm and all clinically significant intact aneurysms. Surgical tactics in the progressive course of aneurysmal disease remains controversial, is subjective, takes into account the clinical type of the disease, the method of turning off aneurysms and the surgeon’s experience.

Repeated surgical interventions are indicated with the progression of aneurysmal disease accompanied by hemorrhage, in all cases of “true recurrence”, detection of de novo aneurysms.

The optimal method for disabling recurrent and pseudorecidive aneurysms is intravascular embolization of the aneurysm with microspirals, including using assistive technologies or flow-bending devices. Open surgeries should be considered only as an alternative treatment method, due to the high risk of intraoperative complications during the isolation and clipping of aneurysms previously undergoing surgical treatment. The lack of clear data on the timing of recurrence and growth of existing aneurysms requires the development of modality and frequency of control postoperative angiographic examinations.

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