• Peyton L Nisson, Ali Tayebi Meybodi, Adam Roussas, Whitney James, Garrett K Berger, Arnau Benet, and Michael T Lawton.
• College of Medicine, University of Arizona, Tucson, Arizona, USA; Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
• World Neurosurg. 2018 Dec 1; 120: e203-e211.

BackgroundOccasionally, previously coiled aneurysms will require secondary treatment with surgical clipping, representing a more complicated aneurysm to treat than the naïve aneurysm. Patients who initially presented with a ruptured aneurysm may pose an even riskier group to treat than those with unruptured previously coiled aneurysms, given their potentially higher risk for rerupture. The objective of this study was to assess the clinical outcomes of patients who undergo microsurgical clipping of ruptured previously coiled cerebral aneurysms. In addition, we present a thorough review of the literature.MethodsA total of 53 patients from a single institution who initially presented with a subarachnoid hemorrhage and underwent surgical clipping of a previously coiled aneurysm between December 1997 and December 2014 were studied. Clinical features, hospital course, and preoperative and most recent functional status (Glasgow Outcome Scale score) were reviewed retrospectively.ResultsThe mean time interval from coiling to clipping was 2.6 years, and mean follow-up was 5.5 years (range, 0.1-14.7 years). Five patients (9.8%) presented with rebleed prior to clipping. Most patients (79.3%, 42/53) experienced good neurologic outcomes. Most showed no change (81%, 43/53) or improvement (13%, 7/53) in functional status after microsurgical clipping. One patient (2%) deteriorated clinically, and there were 2 mortalities (4%).ConclusionsMicrosurgical clipping of previously ruptured, coiled aneurysms is a promising treatment method with favorable clinical outcomes.Copyright © 2018 Elsevier Inc. All rights reserved.

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