Mechanism and prevention of enlargement or new development of aneurysm following treatment by clipping or coiling

The mechanisms of cerebral aneurysm recurrence and enlargement were investigated in 11 patients: two with dissecting aneurysms, six with fully grown aneurysms after neck clipping, one with enlarged aneurysm after dome clipping, and two with enlarged aneurysm due to recanalization after GDC coil embolization. We concluded that it is fundamentally important to ensure complete attachment of the internal elastic lamina around the aneurysm neck by precise neck clipping and effective embolization, with accurate positioning of remaining internal elastic lamina.