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J Neurol Surg Rep 2015; 76(02): e222-e226
DOI: 10.1055/s-0035-1555748
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Management of Ruptured and Rapidly Progressive Mycotic Cerebral Aneurysms in the Setting of Unilateral Carotid Occlusion and Endocarditis with Valve Failure

Robert C. Rennert
1   Division of Neurosurgery, University of California, San Diego, San Diego, California, United States
,
David R. Santiago-Dieppa
1   Division of Neurosurgery, University of California, San Diego, San Diego, California, United States
,
J. Scott Pannell
1   Division of Neurosurgery, University of California, San Diego, San Diego, California, United States
,
Alexander A. Khalessi
1   Division of Neurosurgery, University of California, San Diego, San Diego, California, United States
› Author Affiliations
Further Information

Publication History

13 January 2015

16 May 2015

Publication Date:
03 August 2015 (online)

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Abstract

Mycotic cerebral aneurysms can present unique neurosurgical challenges. We report a patient with left carotid occlusions, a ruptured left middle cerebral artery mycotic aneurysm, and a rapidly appearing unruptured left anterior cerebral artery/anterior communicating artery (ACA/ACom) mycotic aneurysm in the setting of mitral valve endocarditis with a perivalvular leak and evolving congestive heart failure. Following medical stabilization and antibiotic administration, a combined endovascular (with contralateral access via the ACom) and open surgical approach was used to selectively secure both aneurysms with preservation of distal flow, allowing lifesaving cardiac valve replacement. This case illustrates the therapeutic complexity of mycotic cerebral aneurysms, which we discuss in the context of an increasing reliance on endovascular approaches.

Keywords

mycotic aneurysm - middle cerebral artery bifurcation aneurysm - anterior communicating artery aneurysm - endovascular treatment - microneurosurgical treatment
 

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