Intraoperative rupture of cerebral aneurysms during microsurgical clipping as a risk factor of residual aneurysm enlargement

Authors:

Юрий Викторович Пилипенко,

Шалва Шалвович Элиава,

Мухаммаджон Басирхонович Холматов,

Дарья Александровна Старостенко,

Дмитрий Николаевич Окишев,

Антон Николаевич Коновалов,

Фёдор Вячеславович Гребенев

Журнал: Вопросы нейрохирургии имени Н.Н. Бурденко. 2026;90(5):25-31.

DOI: 10.17116/neiro20269005125

Read: 619 раз

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Abstract

BACKGROUND

Aneurysm neck clipping is preferable for saccular aneurysms due to stable occlusion. However, postoperative follow-up angiography reveals residual aneurysm in some cases after clipping. Long-term outcomes depend on clipping quality. Currently, there is no consensus regarding further management of these patients.

OBJECTIVE

To analyze residual cerebral aneurysms within the first year after surgery, and to identify prognostic factors of enlargement and rupture of aneurysm remnant.

MATERIAL AND METHODS

In 2024, clipping of 654 cerebral aneurysms in 550 patients was performed. Residual aneurysms were identified in 49 (7.5%) cases. Clipping quality was estimated in accordance with classification by Yu.V. Pilipenko. Three patients with partial exclusion (R4) underwent redo surgery in early postoperative period. Among 46 patients with residual aneurysms, we enrolled 25 patients with available clinical and angiographic data within one year after surgery.

RESULTS

There were no CT signs of residual aneurysm enlargement in 22 (88%) out of 25 cases. In two patients (8%), enlargement of remnant required redo clipping. Fatal rupture of aneurysm remnant occurred in 1 (4%) case. All three patients experienced intraoperative aneurysm rupture during primary surgery.

CONCLUSION

Intraoperative rupture significantly increases the risk of residual aneurysm enlargement. Localization in Anterior communicating artery (ACjoA) and clipping quality ≥R3 are potential risk factors requiring further studies of larger cohorts.

Keywords

residual aneurysm
incomplete clipping
aneurysm remnant
cerebral aneurysm clipping
aneurysm growth
intraoperative rupture

Конфликт интересов

The authors declare no conflicts of interest.

Дата поступления: 30.03.2026

Дата принятия в печать: 20.07.2026

Дата публикации: 16.10.2026

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