Recurrent Hemorrhage in Patients with Previous Surgery for Cerebral Aneurysms

Among 875 patients with intracranial aneurysm operated on during the past 14 years, the authors encountered eleven who had experienced recurrent hemorrhage caused by the rupture of aneurysms which had not been noticed at the time of the initial operation. The age at the time of initial hemorrhage was relatively young (average 43.7 years), and the interval between initial and recurrent hemorrhage varied between 4 and 16 years. Multiple aneurysms occurred in four cases and hypertension in four others. Clinical grades at the time of the second admission were relatively poor, and in eight patients there were complications with intracerebral hematomas, intraventricular hemorrhages or acute subdural hematoma. Retrospective evaluation of the first angiograms disclosed tiny aneurysms in five cases, and these grew and ruptured at recurrent hemorrhage. In eight patients, the outcome was good; one remained moderately disabled, and two died. We conclude that the possibility of recurrent hemorrhage after the clipping of a ruptured aneurysm should be considered in all aneurysmal patients, especially in those who are young or have multiple aneurysms or hypertension. Their angiograms should be investigated detailly to determine whether or not suspicious tiny aneurysms are present. In addition, late postoperative follow-up angiography to determine the growth or development of another aneurysm might also be needed.