2016 年 44 巻 5 号 p. 385-389
We present a case of recurrent internal carotid artery aneurysm successfully treated with superficial temporal artery-middle cerebral artery (STA-MCA) bypass followed by surgical flow reduction. A 6-year-old boy had a subarachnoid hemorrhage and underwent successful neck clipping at the age of 3 years. Follow-up angiography 3 years after the operation revealed a recurrent aneurysm in the anterior medial part of the internal carotid artery (ICA) near the clip, so he underwent a second operation. Operative findings showed a fusiform aneurysm that was unsuitable for clipping or trapping. Therefore, the aneurysm was treated with STA-MCA bypass followed by proximal occlusions of the ICA and posterior communicating artery. The postoperative course was uneventful, and angiography performed 20 months after the second operation revealed obliteration of the aneurysm. Collateral flow to the right MCA territory before the second operation was sufficient based on the Matas and Alcock test. However, blood flow through the bypass to the right MCA territory increased within 6 months. Our case and previous reports suggest that surgical flow reduction may have a curative effect and few complications of complex aneurysms in pediatric patients. Moreover, low-flow bypass may play a role in preventing chronic complications in such cases.
