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Re-exploration of the craniotomy after surgical treatment of unruptured intracranial aneurysms

  • Clinical Article - Vascular
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Abstract

Background

Unplanned re-exploration of the craniotomy after surgical treatment of unruptured intracranial aneurysms (UIAs) is sometimes required, but the underlying causes and rates of these procedures are seldom reported. This study retrospectively analyzed the causes of such re-explorations to identify methods for decreasing their necessity.

Method

From January 2000 to December 2011, 1,720 patients with a total of 1,938 UIAs underwent surgical treatment at our institution. From this cohort, 26 patients (1.5 %) with 38 UIAs required re-exploration. Clinical data, aneurysm characteristics, treatment methods, and the incidence and causes of re-exploration of the craniotomy were analyzed for these 26 patients.

Results

Several causes of re-exploration were identified: compromised distal blood flow (eight patients, 0.47 %), hemorrhagic venous infarction (four patients, 0.23 %), brain retraction injury (three patients, 0.17 %), newly identified aneurysms (three patients, 0.17 %), bleeding from an incompletely clipped aneurysm (two patients, 0.12 %), epidural hematoma (two patients, 0.12 %), failed aneurysm clipping (two patients, 0.12 %) and other causes (two patients, 0.12 %). Annual re-exploration incidence rates ranged from 0 to 3.1 %. Annual incidence rates gradually decreased following the introduction of several intraoperative monitoring systems.

Conclusions

Precise surgical planning and careful operative techniques can reduce the incidence of unplanned re-exploration of the craniotomy. The introduction of various intraoperative monitoring systems can also contribute to a reduction in this incidence.

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Authors and Affiliations

  1. Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Wonhyoung Park, Jae Sung Ahn, Jung Cheol Park, Do Hoon Kwon, Byung Duk Kwun & Chang Jin Kim

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  1. Wonhyoung Park
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  2. Jae Sung Ahn
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Correspondence to Jae Sung Ahn.

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Park, W., Ahn, J.S., Park, J.C. et al. Re-exploration of the craniotomy after surgical treatment of unruptured intracranial aneurysms. Acta Neurochir 156, 869–877 (2014). https://doi.org/10.1007/s00701-014-2059-z

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