A CASE OF RUPTURED GIANT ANEURYSMS IN A JUVENILE PATIENT

• Published in: Journal of The Showa Medical Association Vol. 59; no. 4; pp. 475 - 480
• Main Authors: MIZUSHIMA, Hidekatsu, HANAKAWA, Kazuo, KOBAYASHI, Nobusuke, SAWABE, Yoshiharu, FURUYA, Hajime, TOYODA, Izumi, MATSUMOTO, Kiyoshi
• Format: Journal Article
• Language: Japanese
• Published: The Showa University Society 1999
• Subjects: Giant aneurysm; subarachnoidal hemorrhage; surgery
• ISSN: 0037-4342; 2185-0976
• DOI: 10.14930/jsma1939.59.475

A 24-year-old male visited our hospital complaining of consciousness disturbance. His conscious level was E1V1M4 on the Glasgow Coma Scale (GCS) . His pupils were 2.5 mm on the right and 5.5 mm on the left side, respectively. A head CT scan revealed a subarachnoid hemorrhage (SAH) with a hematoma (5×3×3 cm) . DSA demonstrated a giant aneurysm of the left middle cerebral artery. The size of the aneurysm was 30×28mm in diameter. After DSA and CT exams, the left pupil declined to midriasis. Within 5 hours after admission, we decided to perform a direct operation. As expected, the brain was very hard and we started a STA-MCA bypass before clipping. During the operation, various methods for brain protection were employed. We conducted neck clipping and external decompression. At that time, the pre-operative enhanced CT was instructive because the aneurysmal wall was not uniform. Hyperbaric oxygen (HBO) therapy was performed 7 times the day after the operation. Postoperative DSA revealed complete neck clipping, but the M2-M3 portion of the MCA could not be detected. A postoperative CT also showed the low-density area of the MCA. Fortunately, the patient recovered from severe SAH and was transferred to the rehabilitation center. One year after first falling ill, the patient's level was E4V5M6 on GCS and he could walk with cane. Repeated DSA revealed that the passage of the M2-M3 portion of the MCA was relatively good. This was a rare case of ruptured giant aneurysm in a juvenile patient.