Abstract: Background  Endovascular therapy is the first treatment choice for intracranial aneurysms currently, but it has a high recurrence rate. Some patients require surgical clipping because of the difficulty of re-embolization. This study retrospectively analyzed the clinical data of 11 cases who underwent clipping operation because of the recurrence after endovascular therapy. Combining with domestic and foreign related literatures, this paper discusses the principles and techniques of surgical treatment for recurrent aneurysms.  Methods  There were a total of 11 patients with 12 recurrent aneurysms after embolization, including 3 anterior communicating artery (ACoA) aneurysms, 3 middle cerebral artery (MCA) aneurysms, 2 posterior communicating artery (PCoA) aneurysms, one anterior cerebral artery (ACA) aneurysm, one vertebral artery (VA) aneurysm, one basilar tip aneurysm and one superior cerebellar artery (SCA) aneurysm. There were 7 small aneurysms and 4 large aneurysms. All patients underwent surgical clipping under microscope. After operation, 11 aneurysms were complete clipped, and one was proximally blocked. The coils were reserved in 7 aneurysms, and were removed or partially removed in 5 aneurysms.  Results  All patients were followed up for an average of 22 months after surgery. There were 9 cases (9/11) with the Glasgow Outcome Scale (GOS) score improved or remaining unchanged compared with preoperation. One of them presented left limb weakness after operation, with the muscle strength Grade 3, while recovered to Grade 4-5 on discharge. The other 2 patients died after surgery. One case had a critical condition before surgery, and the other was secondary to thrombosis and pneumonia. Both of them had a GOS score of 2 when discharged, and died after discharge.  Conclusions  There is high surgical difficulty in recurrent aneurysms, however, with adequate preoperative evaluation and surgical design, it can still promise safe and effective results.

Key words: Intracranial aneurysm, Embolization, therapeutic, Recurrence, Microsurgery, Vascular surgical procedures

摘要： 研究背景 血管内介入治疗是目前颅内动脉瘤的首选治疗方法，但复发率较高，部分患者因再次栓塞困难须行手术夹闭治疗。本文回顾分析行手术夹闭治疗的11 例栓塞不全或复发的颅内动脉瘤患者的临床资料，结合国内外相关文献报道，探讨手术治疗原则和技巧。方法 11 例栓塞不全或复发的颅内动脉瘤患者共有12 个动脉瘤，其中前交通动脉动脉瘤3 个，大脑中动脉动脉瘤3 个，后交通动脉动脉瘤2 个，大脑前动脉、椎动脉、基底动脉尖端和小脑上动脉动脉瘤各1 个；小动脉瘤7 个，大动脉瘤4 个。所有患者均于手术显微镜下行动脉瘤夹闭术，11 个夹闭完全，1 个行椎动脉近端阻断术；术中7 个动脉瘤内弹簧圈予以保留，5 个予以去除或部分去除。结果 所有患者术后平均随访22 个月，Glasgow 预后分级评分较术前增加或无变化9 例（9/11），其中1 例术后左侧肢体肌力减退，肌力3 级，出院时恢复至4 ~ 5 级；2 例死亡，1 例术前病情较重、出院后即死亡，1 例载瘤动脉血栓形成、继发肺炎死亡。结论 血管内介入治疗后复发动脉瘤具有较高的手术难度，只要进行充分的术前评估和手术方案设计，手术夹闭治疗依然能够取得安全有效的效果。

关键词: 颅内动脉瘤, 栓塞, 治疗性, 复发, 显微外科手术, 血管外科手术