{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T12:14:07Z","timestamp":1789820047750,"version":"4.0.1"},"reference-count":34,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Managing multiple intracranial aneurysms (MIAs) in subarachnoid hemorrhages (SAHs) can be challenging, especially when rapid morphological changes such as\n                      <jats:italic>de novo<\/jats:italic>\n                      bleb formation can increase the risk of sequential rupture. In addition, identifying the rupture source is often difficult in the case of symmetrical hematoma distribution.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Case Description:<\/jats:title>\n                    <jats:p>\n                      This study investigated a 66-year-old woman with an SAH and three aneurysms: Right and left internal carotid-posterior communicating (IC-PC) aneurysms and an anterior communicating artery (Acom) aneurysm. Magnetic resonance imaging was contraindicated owing to an intraocular foreign body. Based on size, shape, and intraoperative hematoma, the right IC-PC aneurysm was identified as the rupture source and surgically clipped. On post-operative day 4, a\n                      <jats:italic>de novo<\/jats:italic>\n                      bleb appeared on the untreated left IC-PC aneurysm. Despite the stable diameter, it ruptured on post-operative day 13, causing a second SAH. The left IC-PC aneurysm and Acom aneurysm were clipped. The patient recovered with a Modified Rankin Scale score of 2 at 8 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      This case study highlighted the rapid development of a\n                      <jats:italic>de novo<\/jats:italic>\n                      bleb and subsequent sequential rupture in MIAs. Even aneurysms initially deemed low risk can become unstable within a few days, especially during the vasospasm period. In addition, short-term imaging follow-up is necessary for the early detection of morphological changes. A comprehensive management of MIAs in the acute phase, including the consideration of early treatment for seemingly stable aneurysms, may prevent catastrophic rebleeding.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/sni_838_2025","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:53:04Z","timestamp":1771570384000},"page":"96","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sequential rupture of multiple intracranial aneurysms with rapid\n                    <i>de novo<\/i>\n                    bleb formation: A case report"],"prefix":"10.25259","volume":"17","author":[{"given":"Toshihide","family":"Takahashi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, 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