title: [A Case of Peripheral Middle Cerebral Artery Aneurysm Showing Repeated Morphological Changes].
abstract: We describe a case of a peripheral ruptured middle cerebral artery(MCA)aneurysm showing repeated morphological changes within a short period of 3 months. A 69-year-old woman was admitted to her primary care hospital with headache. Cranial computed tomography (CT) showed subarachnoid hemorrhage (SAH), but ruptured aneurysm was not confirmed on 4-vessel cerebral angiography. Conservative treatment was provided in the form of pain relief and blood pressure control. However, left internal carotid artery angiography (ICAG) conducted 12 days post-onset showed a peripheral MCA aneurysm, which was enlarged 1 week later. The patient did not tolerate balloon test occlusion, showing neurological deficit. Direct surgery was planned, but angiography on day 30 revealed a reduction in aneurysm size. Medical therapy was therefore continued for 1 month; however, the aneurysm showed repeated enlargements over 3 months. The patient therefore consulted our hospital for surgery, which was performed using a transsylvian approach. As we were unable to rule out pseudoaneurysm, we performed superficial temporal artery-MCA anastomosis as a form of trapping surgery. However, the lesion appeared to likely represent a congenital aneurysm when viewed macroscopically, so we performed neck clipping as a definitive treatment. Navigation and motor-evoked potential monitoring were useful to approach the aneurysm and predict the preservation of motor function. Histological examination revealed a congenital aneurysm with organized thrombus. The postoperative course was uneventful and the patient was discharged 2 weeks after surgery without any neurological deficit.
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Inoue
authors.forename: Hideaki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kumon
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ohtsuka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tagawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Seyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takechi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Riko
authors.initials: R
authors.lastname: Kitazawa
authors.forename: Takanori
authors.initials: T
authors.lastname: Ohnishi
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002548:Cerebral Revascularization / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D020768:Middle Cerebral Artery / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D013699:Temporal Arteries / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods