Abstract
We report a case of large MCA aneurysm that ruptured during opening of the dura in surgery. A 41-year-old man was brought in to our hospital following sudden onset of coma with right hemiplegia. Computed tomography revealed severe subarachnoid hemorrhage and a hematoma at the left temporal lobe with midline shift. Cerebral angiography also revealed aneurysms both at the left IC bifurcation and at the left MCA bifurcation. An emergency craniotomy for intracranial decompression was carried out, and then sudden rupture of the aneurysm occurred with arterial bleeding when opening the dura. The MCA aneurysm was successfully clipped in spite of extensive bleeding. Intraoperative aneurysmal rupture occuring in the early stage of operation is not common and the control and treatment of bleeding is quite difficult.
We discuss on the management of intraoperative aneurysmal rupture, especially in the early stage.
