Neurological Surgery No Shinkei Geka Volume 45, Issue 11 (November 2017)

A Case of Multiple Atherosclerotic Fusiform Cerebral Aneurysms with Repeated Subarachnoid Hemorrhage Kotaro OSHIO 1 , Tetsuya IKEDA 1 , Takashi MATSUMORI 1 , Daisuke WAKUI 1 , Hidemichi ITO 1 , Hiroshi TAKASUNA 1 , Yuichiro TANAKA 1 1Department of Neurosurgery, St. Marianna University School of Medicine Keyword: atherosclerosis , fusiform aneurysm , subarachnoid hemorrhage , proximal occlusion , bypass pp.991-996
Published Date 2017/11/10
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 Pure fusiform aneurysms without dissection are considered to have a low risk of rupture. Furthermore, aneurysm wall with atherosclerotic change tends to be less susceptible to rupture. We present a rare case of multiple atherosclerotic fusiform aneurysms associated with repeated subarachnoid hemorrhage(SAH)during a 9-year observation period. A 34-year-old woman was admitted to our hospital because of SAH. SAH with a temporal hematoma due to a fusiform aneurysm of the right middle cerebral artery(MCA)was detected using computed tomography(CT). Associated fusiform aneurysms were observed in the left posterior cerebral artery(PCA)and the left MCA. The right MCA aneurysm was occluded with angioplastic clipping. Eight years after the first onset, angioplastic clipping was performed on the other two fusiform aneurysms because of their growth. Intraoperative findings showed atherosclerotic change in the parent artery wall, similar to the right MCA aneurysms. The right MCA aneurysm ruptured again 1 year later. The aneurysm was treated with proximal occlusion combined with a bypass from the occipital artery to the distal MCA. The patient was in a stable state, although, she was disabled because of SAH damage. The effects of atherosclerotic fusiform aneurysms, which are rarely encountered, are not well known. Some studies have reported the risk of hemorrhage from these aneurysms. This case suggests the necessity of long-term follow-up for the prediction of aneurysm growth and bleeding. Moreover, proximal occlusion combined with an external bypass is better for the treatment of this type of aneurysm because angioplastic clipping is not curative.

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Neurological Surgery 脳神経外科
45巻11号 (2017年11月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院