Miss Clipを思わせた脳動脈瘤再発例

概要

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A case of recurrent cerebral aneurysm after complete neck clipping is described. A 47-year-old male who presented with headache and nausea underwent neck clipping of a berry aneurysm of the left middle cerebral artery. Ten days later, angiographic findings suggested the presence of a second, large aneurysm adjacent to the first, which suggested misplaced clipping. Reoperation confirmed that a new aneurysm had formed next to the original aneurysm. A possible explanation of the recurrence is as follows. The M_1 flowed into the M_2 at a right angle. The aneurysmal neck was situated on the distal end of the M_1 and the dome protruded anteroinferiorly at an angle of nearly 90° to the long axis of the M_1 opposite the origin of the M_2. The parent artery bulged slightly, and its wall was thin and reddish, just distal to the aneurysmal neck. Proximal to the neck there was another small bulge, but the wall here was normal. These bulges were coated with Oxycel^(R) and Biobond^(R) at the time of aneurysmal neck clipping. After clipping, blood flow into the dome was interrupted, and the consequent hemodynamic stress caused the bulges to expand dramatically and form a new aneurysm. The authors conclude that there is a likelihood of early recurrence after neck clipping if the parent artery exhibits such morphological features as observed in this case.
1989-04-15