[Recurrence of cerebral aneurysm after neck clipping--report of a case and review of literature].

A case of recurrent cerebral aneurysm after complete neck clipping is reported. A 38-year-old man was admitted to our service 14 days after attack of subarachnoid hemorrhage. On admission, ruptured left middle cerebral artery aneurysm with intercerebral hematoma and non-ruptured right anterior cerebral artery aneurysm were revealed by radiological examinations. Neck clipping was successfully performed to both of aneurysm and aneurysm was completely disappeard in the postoperative angiographical study. Postoperative course was also uneventful and he was discharged with slight right hemiparesis and motor aphasia. Thirteen months after the neck clipping, however, he was readmitted to our hospital with attack of subarachnoid hemorrhage. After admission, a new aneurysm was noted just under the clip at the right anterior cerebral artery. Neck clipping against this aneurysm was performed by reopening the craniotomy. For his postoperative normal pressure hydrocephalus, ventriculoperitoneal shunt was performed at one month after neck clipping. Postoperative course was uneventful and discharged. From review of literature, it was presumed that hemodynamic stress in the site of aneurysm and injury of arterial wall by the clip may be two major factors as a cause of recurrent aneurysm formation. In our case, possibility of the latter cause was suggested.