Abstract
The cooperative study showed an incidence of 19% for multiplicity of intracranial aneurysms. Nineteen cases with multiple aneurysms were found in 188 verified cases of intracranial aneurysm at Kyoto University Hospital from 1963 to 1972. The incidence was 10.1%.
Here, we are reporting recent three cases with multiple aneurysms, which were admitted in acute stage, i.e. within 14 days after the last hemorrhage.
In the first case, having AC and left MC aneurysms, operative technique was poor. The operation took too much time. The temporary clips were used under induced hypotension. The right A-1 and one of the left frontal opercular branches were occluded. Post-operative angiographies disclosed wide-spread vasospasm from C-2 to A-1-2 and M-1-2 on both sides. On the 12th postoperative day the patient expired.
In the second with AC and right MC aneurysms, operative treatment was not undertaken because the patient was moribund. Angiographies showed widespread spasm and intracarotid administration of 20 mg of POB gave no effect.
The third patient had had right common carotid ligation for right ICPC aneurysm in 1965. In October 1971, sudden onset of severe headache and exaggeration of right ptosis made the patient be readmitted. Right ICPC aneurysm was visualized through the left vertebral angiography. Right frontotemporal craniotomy and neck' clipping of the aneurysm were performed without any difficulty, and the patient was discharged on the 10th postoperative day. However, 8 days after discharge he suffered severe headache again, then became comatose, and died. Post-mortem examination revealed an unsuspected ruptured aneurysm at AC. Retrospective careful examination of the angiograms under second-order subtraction showed the presence of the AC aneurysm.
