Cases of New Growth and Rebleeding of Cerebral Aneurysm After Surgical Management

• Published in: Nōshotchū no geka Vol. 15; no. 4; pp. 384 - 388
• Main Authors: KUSAKA, Kazumasa, NISHIYAMA, Kazuhide, KANEKO, Fumihito, KANNUKI, Seiji, MATSUMOTO, Keizo
• Format: Journal Article
• Language: English; Japanese
• Published: The Japanese Society on Surgery for Cerebral Stroke 20.11.1987
• Subjects: cerebral aneurysm; new growth; rebleeding; surgical management
• ISSN: 0914-5508; 1880-4683
• DOI: 10.2335/scs1987.15.4_384

We have experienced direct neck clipping surgery for cerebral aneurysms in 854 cases during the 15-year period from 1971 to 1985. In this series of aneurysmal surgery, postoperative complications of rebleeding and new growth of an aneurysm at the site of the clipped aneurysm were seen in two cases. [Case I] A 37-year-old man was admitted to our service complaining of severe headache. An aneurysm was revealed at the junction of the left internal carotid artery and the ophthalmic artery by four vessel angiography. The left common carotid artery was ligated because it was assumed preoperatively that neck clipping would be difficult. One month after surgery, the patient again complained of severe headache. Right carotid angiography revealed an aneurysm at the junction of the right internal carotid artery and the posterior communicating artery which had never appeared in previous angiography. Neck clipping was successfully performed on this newly developed aneurysm. Four years after the last neck clipping, cerebral angiography failed demonstrate any further aneurysmal growth. This was a very noteworthy clinical case, because a new aneurysm developed in a short period, probably within one month. The increased hemodynamic stress was considered to be the pathogenesis of a newly developed aneurysm after contralateral ligation of the common carotid artery. [Case II] A 38-year-old man was admitted to our service 14 days after the onset of subarachnoid hemorrhage. A ruptured left middle cerebral artery aneurysm and a non-ruptured right anterior cerebral artery aneurysm were revealed by radiological examinations. Neck clipping was successfully performed on both aneurysms and the postoperative angiogram demonstrated the disappearance of the aneurysm. The patients postoperative course was uneventful. Thirteen months after the neck clipping, however, he was readmitted to our hospital with subarachnoid hemorrhage. A newly developed aneurysm was noted just under the clip at the right anterior cerebral artery. Neck clipping was perfomed on this new aneurysm. The postoperative course was uneventful and he was discharged with no neurological deficit. Hemodynamic stress at the site of an aneurysm and injury of the arterial wall by on inadequate clip were considered to be the major cause of the aneurysmal formation.