Serial Changes of Residual Neck, Followed after Clipping Surgery

The prognosis of residual neck following clipping surgery is not sufficiently documented. The purpose of this study is to determine the serial changes of residual neck after clipping surgery. Between 1974 and 1997, 22 patients under the age of 70 years with residual neck were followed by serial angiographies for a mean of 3.4 years (range 1 year to 9 years). Initial angiography was performed 1 year after the surgery and further studies were done every 1-2 years subsequently. The location of aneurysms were 13 internal carotid artery (IC)(1 IC-cave, 1 IC-ophthalmic, 7 IC-posterior communicating artery, 2 IC-anterior choroidal artery, 2 carotid-bifurcation), 7 middle cerebral artery, 1 anterior communicating artery and 1 peripheral anterior cerebral artery. The results showed 18 residual necks remained unchanged, 3 were obliterated spontaneously after 1 year, 1 year and 3 years respectively from the surgery, and 1 was enlarged after 6 years. Two important issues were clarified. First, residual necks should be observed with serial angiographies since the regrowth from residual neck is possible. Second, in the initial clipping surgery, we must seek to achieve complete clipping without residual neck using special techniques such as intraoperative endoscope.