Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 394-396
DOI: 10.4103/ajns.AJNS_23_20
Case Report

Morphological change of cerebral aneurysm with possible pseudoaneurysm at A2/3 of the anterior cerebral artery on three-dimensional computed tomographic angiography

Atsushi Tsukiyama
1   Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki
2   Department of Neurological Surgery, Nippon Medical School, Tokyo
,
Toshiki Nozaki
1   Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki
2   Department of Neurological Surgery, Nippon Medical School, Tokyo
,
Shutaro Matsumoto
1   Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki
3   Department of Neurosurgery, Yokohama City University, Yokohama
,
Toshimasa Uekusa
4   Department of Pathology, Kanto Rosai Hospital, Kawasaki
,
Atsushi Tsuchiya
5   Department of Neurology, Kanto Rosai Hospital, Kawasaki
,
Motohiro Nomura
1   Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki
6   Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Intracranial pseudoaneurysm formation due to a ruptured nontraumatic aneurysm is rare. We describe a case of ruptured aneurysm, which showed morphological change on radiological examinations. An 83-year-old woman developed subarachnoid hemorrhage (SAH) with ventricular rupture and intracerebral hematoma in the corpus callosum. Contrast-enhanced computed tomography (CE-CT) demonstrated an aneurysm at the right A2/3 junction of the anterior cerebral artery. CE-CT repeated 17 h after the initial one showed shortening of the lesion on both three-dimensional and raw images. The aneurysm was surgically clipped. In cases of SAH with a hematoma or thick SAH, there is a possibility that a pseudoaneurysm will form at the tip of the true aneurysm in an adjacent thrombus or existence of intraluminal thrombus. The morphology may change during the period between initial radiological evaluation and the operation in these cases. We should be aware that the intraoperative findings or subsequent radiological findings might be different from those observed on preoperative radiological examinations.

Key-words:

Cerebral aneurysm - morphological change - pseudoaneurysm - subarachnoid hemorrhage - three-dimensional computed tomographic angiography

Financial support and sponsorship

Nil.




Publication History

Received: 17 January 2020

Accepted: 18 April 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Lempert TE, Halbach VV, Higashida RT, Dowd CF, Urwin RW, Balousek PA, et al. Endovascular treatment of pseudoaneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 1998;19:907-11.
  • 2 Teitelbaum GP, Dowd CF, Larsen DW, McDougall CG, Halbach VV, Higashida RT, et al. Endovascular management of biopsy-related posterior inferior cerebellar artery pseudoaneurysm. Surg Neurol 1995;43:357-9.
  • 3 Nomura M, Kida S, Uchiyama N, Yamashima T, Yoshikawa J, Yamashita J, et al. Ruptured irregularly shaped aneurysms: Pseudoaneurysm formation in a thrombus located at the rupture site. J Neurosurg 2000;93:998-1002.
  • 4 Ide M, Kobayashi T, Tamano Y, Hagiwara S, Tanaka N, Kawamura H. Pseudoaneurysm formation at the rupture site of a middle cerebral artery aneurysm – Case report. Neurol Med Chir (Tokyo) 2003;43:443-6.
  • 5 Mori K, Kasuga C, Nakao Y, Yamamoto T, Maeda M. Intracranial pseudoaneurysm due to rupture of a saccular aneurysm mimicking a large partially thrombosed aneurysm (”ghost aneurysm”): Radiological findings and therapeutic implications in two cases. Neurosurg Rev 2004;27:289-93.
  • 6 Tanoue S, Kiyosue H, Matsumoto S, Yamashita M, Nagatomi H, Mori H. Ruptured “blisterlike” aneurysm with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization. Case report. J Neurosurg 2004;101:159-62.
  • 7 Ding H, You C, Yin H. Nontraumatic and noninfectious pseudoaneurysms on the circle of Willis: 2 case reports and review of the literature. Surg Neurol 2008;69:414-7.
  • 8 D'Urso P, Loumiotis I, Milligan BD, Cloft H, Lanzino G. “Real time” angiographic evidence of “pseudoaneurysm” formation after aneurysm rebleeding. Neurocrit Care 2011;14:459-62.
  • 9 Yanamadala V, Lin N, Zarzour H, Frerichs KU, Walcott BP, Thomas AJ, et al. Endovascular coiling of a ruptured basilar apex aneurysm with associated pseudoaneurysm. J Clin Neurosci 2014;21:1637-40.
  • 10 Nomura M, Tamase A, Kamide T, Mori K, Seki S, Yanagimoto K. Pseudoaneurysm formation in intracerebral hematoma due to ruptured middle cerebral artery aneurysm. Surg J (N Y) 2015;1:e47-9.
  • 11 Ito H, Morishima H, Onodera H, Wakui D, Uchida M, Sase T, et al. Acute phase endovascular intervention on a pseudoaneurysm formed due to rupture of an anterior communicating artery aneurysm. J Neurointervent Surg 2015;7:e9.
  • 12 Ito H, Sase T, Uchida M, Wakui D, Onodera H, Morishima H, et al. Coil embolization of a ruptured anterior communicating artery aneurysm forming a pseudoaneurysm: Report of three cases. No Shinkei Geka 2016;44:323-8.
  • 13 Nomura M, Mori K, Tamase A, Kamide T, Seki S, Iida Y, et al. Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review. Neuroradiol J 2017;30:129-37.