Four Cases of Rebleeding After Neck Clipping of an Aneurysm

Early rebleeding after neck clipping occurred in four among 218 patients who underwent direct surgery on an intracranial aneurysm. In three cases of internal carotid artery aneurysm, hemorrhage occurred during two to five days after the operation. A significant portion of the aneurysm remained in two cases and a small portion of the neck remained in one case on angiography after rebleeding. In a case of anterior communicating artery aneurysm, rebleeding occurred on the 21st postoperation day. On angiographyp erformed on the fourth day after neck clipping, the aneurysm was completely, obliterated. However, a new aneurysm grew in another portion of anterior communicating artery on angiography after rebleeding. The mechanism of development of the new aneurysm was presumed to be that the arterial wall was injured by tweezers during surgical manipulation of the arteries and hypertensive-hypervolemic therapy after the operation accelerated the development of the new aneurysm.If there is doubt concerning misplacement or incomplete placement of a clip during surgery, angiography just after the operation is of great value in planning a reoperation, but it will be very difficult to predict the development of a new aneurysm and to plan for follow-up angiography before rebleeding.