Abstract
A 38 year-old-female presented with subarachnoid hemorrhage due to rupture of the left internal carotid artery-posterior communicating artery (IC-PC) aneurysm. The aneurysm was clipped on the day of onset. Postoperative carotid angiography (CAG) revealed an infundibular dilatation (ID) at the origin of the right posterior communicating artery. Therefore follow-up of the ID was carried out by right CAG after 3.5 years, and a development of the ID into a saccular aneurysm was verified. This newly developed right IC-PC aneurysm was clipped by the second operation. About 7 years after the first operation, she experienced transient ischemic attacks of left internal carotid artery twice in a short period. Therefore a third left CAG was performed, and development of a previously overlooked small aneurysm of the internal carotid bifurcation into a saccular one was detected. The third aneurysm was clipped by the third operation. She has been well throughout her clinical course.
She was specific in whom two aneurysms developed newly after the operation of a ruptured aneurysm, and these two aneurysms were operated on successfully prior to an occurrence of bleeding from the newly developed aneurysms.
In this paper, the genesis and growth of cerebral aneurysm are discussed. We emphasize the necessities of detailed analysis of the initial angiogram and of follow-up of a small aneurysm and pre-aneurysmal lesion including ID by angiography.
