Neurological Surgery No Shinkei Geka Volume 43, Issue 8 (August 2015)

A Case of Peripheral Middle Cerebral Artery Aneurysm Showing Repeated Morphological Changes Akihiro INOUE 1 , Hideaki WATANABE 1 , Yoshiaki KUMON 2 , Yoshihiro OHTSUKA 1 , Masahiko TAGAWA 1 , Takeshi SEYAMA 3 , Akihiko TAKECHI 3 , Yosuke MIZUNO 4 , Riko KITAZAWA 4 , Takanori OHNISHI 1 1Department of Neurosurgery, Ehime University School of Medicine 2Department of Regeneration of Community Medicine, Ehime University School of Medicine 3Department of Neurosurgery, Matsuyama Red Cross Hospital 4Division of Diagnostic Pathology, Ehime University School of Medicine Keyword: peripheral middle cerebral artery aneurysm , subarachnoid hemorrhage , repeated morphological change , congenital aneurysm pp.713-719
Published Date 2015/8/10
  • Abstract
  • Look Inside
  • Reference

 We describe a case of a peripheral ruptured middle cerebral artery(MCA)aneurysm showing repeated morphological changes within a short period of 3 months. A 69-year-old woman was admitted to her primary care hospital with headache. Cranial computed tomography(CT)showed subarachnoid hemorrhage(SAH), but ruptured aneurysm was not confirmed on 4-vessel cerebral angiography. Conservative treatment was provided in the form of pain relief and blood pressure control. However, left internal carotid artery angiography(ICAG)conducted 12 days post-onset showed a peripheral MCA aneurysm, which was enlarged 1 week later. The patient did not tolerate balloon test occlusion, showing neurological deficit. Direct surgery was planned, but angiography on day 30 revealed a reduction in aneurysm size. Medical therapy was therefore continued for 1 month;however, the aneurysm showed repeated enlargements over 3 months. The patient therefore consulted our hospital for surgery, which was performed using a transsylvian approach. As we were unable to rule out pseudoaneurysm, we performed superficial temporal artery-MCA anastomosis as a form of trapping surgery. However, the lesion appeared to likely represent a congenital aneurysm when viewed macroscopically, so we performed neck clipping as a definitive treatment. Navigation and motor-evoked potential monitoring were useful to approach the aneurysm and predict the preservation of motor function. Histological examination revealed a congenital aneurysm with organized thrombus. The postoperative course was uneventful and the patient was discharged 2 weeks after surgery without any neurological deficit.

Copyright © 2015, Igaku-Shoin Ltd. All rights reserved.


Neurological Surgery 脳神経外科
43巻8号 (2015年8月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院