Clinical analysis of recurrent subarachnoid hemorrhage after neck clipping surgery

The clinical features of recurrent subarachnoid hemorrhage (SAH) after neck clipping surgery were investigated in a series of 1,436 consecutive patients treated between 1980 and 1994, and seven patients treated prior to 1980. Recurrent SAH occurred within 1 month in seven patients and between 1.5 and 20 years in 20 patients (mean interval 9.2 years) from the first surgery. The patients were aged from 31 to 76 years (mean 49.8 years) at the first SAH. There were 19 females and eight males. Recurrent SAH occurred at the same site as the prior aneurysms in 12 cases, at an infundibular dilatation in three cases, de novo aneurysms in nine cases, untreated multiple aneurysms in two cases, and unknown in one case. The main causes for early recurrent SAH were incomplete clipping or untreated multiple aneurysms, whereas late recurrent SAH was due to de novo aneurysms, untreated multiple aneurysms, or regrowth aneurysm at the prior site. The outcomes of late recurrent SAH were good in eight cases, moderate disability in two, severe disability in three, and dead in seven, whereas most cases of early recurrent SAH resulted in poor outcome. Immediate postoperative angiography is desirable in cases with incomplete clipping, because early recurrent SAH resulted in poor outcomes. De novo or regrowth aneurysms caused late recurrent SAH, so follow-up angiography is strongly recommended for young patients, even if complete clipping was achieved.