Pericallosal artery aneurysm – Case report, literature review and management outcome

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Abstract

Highlights • Pericallosal artery aneurysms are rare. • They have a higher rupture rate than other anterior circulation intracranial aneurysms. • These vascular lesions often present with pericallosal intracerebral hematoma. • Surgical approaches to these aneurysms are associated with a high complication rate. • Successful management is possible in our low-resource neurosurgical facility.

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Most cited references 19

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Pattern of cerebral aneurysms in Morocco: review of the concept of their rarity in developing countries: report of 200 cases.

D M Sabah, S. Derraz, A. El-Lakany … (2001)

Many neurosurgeons consider cerebral aneurysms to be rare in Africa and the Middle East. In this report, we describe the pattern of cerebral aneurysms in Morocco and call into question the idea of their rarity in developing countries. Our objective is to urge neurosurgeons in these areas to track them and to treat them under better conditions. We report a retrospective study of 200 patients with cerebral aneurysms admitted to our department between 1983 and 1999. The results of this study are supported by pertinent epidemiological surveys, anatomic studies on the incidence of cerebral aneurysms in Morocco, and analysis of the literature related to the epidemiology of aneurysms in developing countries. The patients in our series ranged in age from 7 to 70 years (mean age, 52 yr), with a slight female predominance (52%). They presented with subarachnoid hemorrhage (173 patients), cranial nerve palsy (18 patients), or mass symptoms (9 patients). The delay between subarachnoid hemorrhage and admission ranged from 1 to 30 days (mean, 14 d). The aneurysm was located in the internal carotid artery in 42%, in the anterior communicating and anterior cerebral arteries in 28%, in the middle cerebral artery in 19%, and in the vertebrobasilar artery in 10%. Multiple aneurysms were encountered in 9% and giant aneurysms in 15.5%. Seventeen patients died before surgery (with vasospasm in 13 cases and rebleeding in 4 cases), and 19 died after surgery. Follow-up, ranging between 1 and 10 years, revealed good outcomes with complete recovery in 64.5% and recovery with major sequelae in 7%. Pre- and postoperative mortality represented 18%; there was no operative treatment and no follow-up in 11.5%. Some data in this study (the delay between subarachnoid hemorrhage and admission, the high incidence of urban patients [80%], and the high rate of giant aneurysms) explain why many cases of ruptured aneurysms are not diagnosed. The analysis of our clinical series and the results of the epidemiological surveys show that the incidence has doubled every 5 years. These findings confirm that cerebral aneurysms are not rare in Morocco. A critical reading of the published articles claiming a low incidence of cerebral aneurysms in Africa, the Middle East, and Asia shows that this conclusion is not based on accurate and reliable statistical studies. Neurosurgeons in these regions should abandon this idea of rarity, and they should search for arterial cerebral aneurysms and develop the optimum conditions for the treatment of patients with aneurysms.

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Cerebral arteriovenous malformations with associated arterial aneurysms: hemodynamic and therapeutic considerations.

J. Tucker, S Spiegel, Nicola Nixon … (1988)

The common vascular anomalies of cerebral aneurysm and arteriovenous malformation may exist independently, or together as part of a closely related hemodynamic pairing. Resection or embolization of an AVM may be followed by a decrease in local blood flow, and lead to regression of a suitably situated proximal aneurysm. However, aneurysms located outside the angioarchitecture of the AVM, which remain flow-unrelated to the malformation, will likely not regress, and may in fact enlarge. Two cases are presented which demonstrate these vascular relationships, in order to better understand the regional hemodynamics of these anomalies prior to surgical or endovascular treatment planning.

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Traumatic pericallosal artery aneurysm: a rare complication of transcallosal surgery. Case report.

Jeff Dunn, G Edward Vates, Derek Smith … (2007)

Traumatic intracranial aneurysms are rare in adults but account for up to 33% of all aneurysms encountered in a pediatric population. The most common location of such lesions in children is the pericallosal or adjacent branch of the anterior cerebral artery, where a head impact exerts sudden decelerating shearing forces on the arteries tethered on the brain surface against an immobile falx cerebri, weakening the arterial wall. This action can lead to dissection of the damaged vascular layers, with resultant expansion of the affected site into a fusiform aneurysm. Pericallosal aneurysms following a penetrating intracranial injury have also been described, and the resultant lesion in some cases can be a pseudoaneurysm. The incidence of iatrogenic pericallosal artery aneurysms, however, is extremely rare. The authors describe the first reported case of a traumatic pericallosal artery aneurysm following transcallosal surgery. This 6-year-old boy underwent resection of a hypothalamic pilocytic astrocytoma, which was approached via the transcallosal corridor. A follow-up magnetic resonance image obtained within 1 year of surgery disclosed a small flow void off the right pericallosal artery, which was initially interpreted as residual tumor. Serial investigations showed the lesion enlarging over time, and subsequent angiography revealed a round 7-mm pericallosal artery aneurysm with an irregularly shaped 2- to 3-mm lumen. The aneurysm was difficult to treat with clip reconstruction or suturing of the affected segment, and an excellent outcome was ultimately achieved with resection of the lesion and autogenous arterial graft interposition. The authors also discuss the likely pathophysiology of the aneurysm and the surgical procedures undertaken to treat it.