Residual Cerebral Aneurysms After Microsurgical Clipping: A New Scale, an Agreement Study, and a Systematic Review of the Literature

Residual lesions in patients undergoing microsurgical clipping of cerebral aneurysms in a reference university hospital

“…Since its description by Walter Dandy in 1938, microsurgical occlusion of cerebral aneurysms using metal clips has been employed as the definitive treatment of this condition ( 2 , 6 , 10 ). The emergence and refinement of endovascular intervention techniques for treating cerebral aneurysms have led to the inevitable comparison of the efficacy of the two modalities.…”

“…Given the clear need for long-term follow-up of operated aneurysms, these lesions should be controlled by using imaging. Although many studies have employed computed tomography angiography and magnetic resonance angiography for follow-up, DSA remains the method offering best accuracy and specificity for diagnosing residual lesions after microsurgical treatment of cerebral aneurysms ( 2 , 14 , 15 ). DSA yields information on clip position, presence of residual lesions, occlusion, or stenosis of adjacent vessels, and the presence of other untreated aneurysms ( 12 ).…”

“…The fact that residual aneurysms require attention and care has been recognized since the 1960s, following the studies of Drake et al ( 2 , 9 , 16 , 17 ). Besides posing a risk of bleeding, some authors have suggested that residual lesions can evolve with spontaneous thromboses ( 12 , 16 ).…”

“…Major advances in the diagnosis and management of cerebral aneurysms have been made in the past 30 years ( 1 ). Generally, the ultimate goal of aneurysm treatment is to achieve complete occlusion while avoiding rupture or rebleeding ( 2 ) and preserving the patency of adjacent arteries. This treatment can be performed using microsurgical techniques or the endovascular approach ( 1 - 3 ).…”

“…Recent studies attribute greater rates of complete occlusion of aneurysms to microsurgery ( 4 - 6 ). Although microsurgical clipping seems to be the most effective and durable treatment ( 2 , 7 ), most studies that investigate this treatment have no postoperative control group to confirm this theory.…”