Intraoperative Rupture of Unruptured Cerebral Aneurysm during Craniotomy: A Case Report

An unruptured aneurysm was incidentally found in the right middle cerebral artery in a 67-year-old woman. During an attempt to turn the temporalis muscle for surgical clipping, systolic blood pressure suddenly increased. After opening the dura mater, we found a subarachnoid hemorrhage and severe bra...

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Bibliographic Details
Published in:Case reports in neurology 2017-11, Vol.9 (3), p.261-266
Main Authors: Yoshiki, Kenji, Misaki, Kouichi, Nambu, Iku, Fukui, Issei, Mohri, Masanao, Uchiyama, Naoyuki, Nakada, Mitsutoshi
Format: Article
Language:English
Subjects:
Aneurysms
Blood pressure
Case Report
Case reports
Cerebral aneurysm
Clipping
Craniotomy
Flow velocity
Fluid dynamics
Hemorrhage
Hypotheses
Intraoperative rupture
Medical imaging
Veins & arteries
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Summary:An unruptured aneurysm was incidentally found in the right middle cerebral artery in a 67-year-old woman. During an attempt to turn the temporalis muscle for surgical clipping, systolic blood pressure suddenly increased. After opening the dura mater, we found a subarachnoid hemorrhage and severe brain swelling. We promptly expanded the craniotomy area to reach the aneurysm while pulling part of the frontal lobe to apply a clip. We retrospectively analyzed the aneurysm using computational fluid dynamics. Our analysis suggests that the rupture of the aneurysm occurred at a location with very low wall shear stress.
ISSN:1662-680X
1662-680X
DOI:10.1159/000480425