クリッピング後，その近傍に新たに発生し極めて短期間に破裂に至った脳動脈瘤

Rapid Growth and Rupture of Newly Originated Aneurysm near the Clipped Middle Cerebral Artery Aneurysm

I．はじめに

　現在，脳動脈瘤の最も確実で安全な治療方法は，頭蓋内直達手術による柄部クリッピングであることは論をまたない．しかし一方では，少数ながらクリッピング後の再発例も報告されている．

　われわれは破裂中大脳動脈瘤クリッピング後，全経過がわずか12日という極めて短期間にクリップの近位側に新たな動脈瘤が発生，増大し破裂に至った特異な症例を経験した．

A 38-year-old man was admitted to our hospital because of severe headache following reduced level of consciousness on February 13, 1979. He was lethargic and showed neck stiffness. A lumbar punc-ture revealed bloody cerebrospinal fluid. Left carotid angiography showed a berry aneurysm of 11 mm in diameter at the bifurcation of the middle cerebral artery (MCA). Rebleeding occurred on February 21, and he fell into semicoma. But, his consciousness recovered to lethargy on the next clay. On February 26, a direct intracranial operation was performed and a Sugita clip was placed to the aneurysmal neck.