著者

中川 忠 小股 整 鎌田 健一

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.38, no.3, pp.186-190, 2010 (Released:2010-10-27)

参考文献数

19

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We report a rare case of a 15-year-old male with multiple saccular aneurysms. He experiences dizziness while riding a bicycle and fell. On admission, he was drowsy but had no other neurological deficits. A brain CT scan demonstrated diffuse subarachnoid hemorrhage. A cerebral angiogram revealed a left internal carotid artery-anterior choroidal artery (IC-Ac) aneurysm (AN) with a bleb, a left basilar artery-superior cerebellar artery (BA-SCA) AN, a small left anterior cerebral artery (A1A2) AN and a right M1M2 portion of middle cerebral artery (M1M2) AN. The left IC-Ac AN seemed to be ruptured. The left ruptured IC-Ac and left unruptured BA-SCA ANs were clipped on Day 1. About 1 year later the right M1M2 AN was clipped, but the left A1A2 AN could not be clipped via a trans-sylvian approach because of its high position at 1 stage operation. The small left A1A2 AN was periodically followed up with MRA for 3 years. Since it increased in size, it was clipped via an inter-hemispheric approach. All 4 ANs were completely clipped on postoperative angiogram. Adolescents and adults display different clinical features in ANs. The biggest treatment difficulty is the higher incidence of giant ANs of the IC bifurcation and vertebro-basilar ANs in adolescents than in adults, and thus therapeutic strategy should be considered on a case-by-case basis.