Growth And Spontaneous Regression Of A Middle Cerebral Artery Aneurysm After Surgical Clipping
Tan, C. B., Rodesh, G., & Lasjaunias, P. (2001). Growth and spontaneous regression of a middle cerebral artery aneurysm after surgical clipping. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 7(2), 147–151. https://doi.org/10.1177/159101990100700210
View Original Source →Abstract
We present a case of growth and spontaneous regression of a middle cerebral artery aneurysm after surgical clipping. A 36-year-old woman who presented with grade II subarachnoid haemorrhage was found to have a right middle cerebral artery aneurysm. The aneurysm was surgically clipped in view of the morphology of the aneurysm. Second clipping was performed four months later as there was re-growth of the neck of the aneurysm. Again re-growth of the aneurysm was noted five months after the second clipping. As further clipping of the aneurysm would be difficult, external and internal carotid arteries bypass was the treatment option but unfortunately, the by-pass operation was unsuccessful. Interestingly, angiogram performed after the bypass surgery revealed partial thrombosis and decreasing size of the aneurysm. Complete obliteration of the aneurysm was noted without further intervention one month after the failed by-pass surgery.
Case Details
Disease Location
Brain
Personal Characteristics
36 years old woman
Clinical Characteristics
Presented with headache in december 1999. There was no neurological deficit on examination. CT scan of the brain revealed intracerebral hemorrhage at the right temporal lobe and hunt and hess grade ii subarachnoid hemorrhage. Cerebral angiogram demonstrated a wide neck aneurysm at right middle cerebral artery (mca) bifurcation. Surgical clipping was elected and performed. A remanent of the aneurysm was found at the neck. Follow-up cerebral angiogram in april 2000 revealed re-growth of the aneurysm. Second clipping of the aneurysm was performed. The neck remanent of the aneurysm slightly enlarged over the following two months and enlarged further to become a bilobed aneurysm subsequently in september 2000. External carotid and internal carotid arteries by-pass followed by endovascular sacrifice of the mca was performed unseccesfully.
Remission Characteristics
Complete oblitearion of the aneurysm and right middle cerebral artery at its bifurcation was demonstrated after failed by-pass.
Treatment & Mechanisms
Proposed Remission Mechanisms
Endothelial repair exceeded endothelial destruction.
Clinical Treatment
Surgical clipping (two times) and an unsuccess bypass operation.