術中にneckが裂けた未破裂IC-PC巨大動脈瘤の1例(<特集>未破裂脳動脈瘤治療に伴うトラブル)  [in Japanese] A Case of Giant IC-PC Unruptured Aneurysm with Intraoperative Rupture at the Neck(<Topics>Problems in Clipping Surgery for Unruptured Cerebral Aneurysm)  [in Japanese]

Intraoperative aneurysmal rupture at the neck may result in a disastrous postoperative course. We report a case of giant IC-PC unruptured aneurysm successfully treated by an unreported method. A 67-years-old male was admitted to our department because of abnormal behavior. CT scan and MR image demonstrated a mass lesion compressing the right cerebral peduncle measuring 4.5 cm in maximal size. A cerebral angiogram revealed an IC-PC aneurysm on the right side. Therefore, we diagnosed a subtotally thrombosed giant IC-PC aneurysm. At surgery, the aneurysm had a surprisingly narrow neck and looked clippable. Massive bleeding occurred at the neck during application of an angled clip. Following temporary clipping of the internal carotid artery, opening of the aneurysm fundus near the neck was followed by removal of some thrombus. Application of an angled fenestrated clip at the lacerated neck with one blade inserted into the cavity of the aneurysm resulted in no bleeding without stenosis of the internal carotid artery.