A case of postoperative massive enlargement of intracranial aneurysm associated with many vascular abnormalities
Fukuda, M.; Sugiyama, Y.; Kawasaki, S.; Hondo, H.
No Shinkei Geka. Neurological Surgery 8(8): 773-779
1980
ISSN/ISBN: 0301-2603 PMID: 7422067 Document Number: 163845
A 44 yr old female had massive enlargement of an internal carotid bifurcation aneurysm, 8 yr after coating operation, associated with occlusion of the ipsilateral internal carotid artery and development of contralateral multiple aneurysms. She was first admitted because of subarachnoid hemorrhage with left hemiparesis. Bilateral carotid angiography only revealed an aneurysm of the right internal carotid bifurcation. When she was cured of left hemiparesis and heart disease by conservative therapy 4 mo. after admission, the operation was performed by right fronto-temporal approach under hypothermal anesthesia. The right internal carotid bifurcation was exposed; the aneurysm had a broad neck and the middle cerebral artery was buried in the aneurysmal wall. Ethylacrylate was used to coat the whole surface of the aneurysm. Recovery was uneventful and she was discharged. She remained asymptomatic until 8 yr later, when left hemiparesis developed and progressed slowly. She was readmitted after 4 mo. because of progression of the left hemiparesis, speech disturbance and urinary incontinence. Examination at that time revealed apallic and apathic state, moderately mydriatic pupils with atrophic optic discs and left hemiparesis with pathological reflexes. Skull film showed a ring-shaped calcification, measuring 37 .times. 28 mm, at the supraclinoidal portion. Demineralization of the bone was not seen. CT scan showed a large high density area in the right frontal region with marginal higher density zone and a low density area in the right temporal region. Right carotid angiography showed that the internal carotid artery was occluded at C 2 portion and the aneurysm was not seen. The pre-existed aneurysm of the internal carotid bifurcation apparently was enlarged and thrombosed completely. Left carotid angiography showed 4 saccular aneurysms (rt-A. 2, lt-A. 2, Aco. and lt-M. 2) and the megadolicho middle cerebral artery, which were not recognized 8 yr previously. No definitive treatments were given and she was discharged when her overall condition improved. The giant aneurysm grew as a result of repeated minor leakage at the portion of incomplete coating and the subsequent mesenchymal reaction. The complete thrombosis of the aneurysm lumen extended to the parent artery and resulted in the internal carotid artery occlusion. Development and growth of multiple aneurysms might occur without other vascular accidents, even though they were encouraged by the giant aneurysm and subsequent internal carotid artery occlusion.