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Ruptured cerebral pseudoaneurysm caused by the removal of a ventricular catheter. Case report
R Shirane1, T Kondo, Y K Yoshida
1Department of Neurosurgery, Tohoku University, School of Medicine, Sendai, Japan. reizo@nsg.med.tohoku.ac.jp
Insights
A rare cerebral pseudoaneurysm in an infant resulted from ventricular catheter removal, causing internal carotid artery damage. Careful catheter extraction is crucial to prevent such serious complications.
Area of Science:
- Pediatric Neurosurgery
- Vascular Neurology
- Medical Device Complications
Background:
- Ventriculoperitoneal shunt revision is a common procedure in infants.
- Complications during ventricular catheter removal can occur, including intraventricular hemorrhage.
Observation:
- A 4-month-old infant developed a pseudoaneurysm of the internal carotid artery (ICA) after ventricular catheter removal.
- The procedure led to intraventricular and subarachnoid hemorrhage, ICA stenosis, and aneurysm formation.
Findings:
- The pseudoaneurysm originated from the ICA at the anterior choroidal artery (AChA) origin.
- Surgical treatment successfully removed the pseudoaneurysm and reconstructed the ICA.
Implications:
- This case highlights the risk of remote pseudoaneurysm formation due to catheter-induced avulsion of the AChA.
- Extreme caution and precision are necessary during ventricular catheter removal to avoid severe vascular injury.
Abstract:
A rare case of cerebral pseudoaneurysm located at the internal carotid artery (ICA) was caused by the removal of a ventricular catheter in an infant. This 4-month-old girl underwent ventriculoperitoneal shunt revision, during which the old ventricular catheter was removed from the posterior horn of the left lateral ventricle, but the choroid plexus was pulled out by the tip of the catheter. Intraventricular hemorrhage (IVH) and subarachnoid hemorrhage were observed postoperatively. Magnetic resonance (MR) angiography performed on the 12th postoperative day revealed ICA stenosis and aneurysm formation at the C1 portion of the left ICA. Contrast-enhanced computerized tomography (CT) scans obtained on the 21st postoperative day revealed recurrent IVH and enlargement of the lesion. The patient underwent surgery for treatment of the aneurysm. Operative findings revealed a pseudoaneurysm arising from the left ICA at the proximal end of the anterior choroidal artery (AChA). The aneurysm was removed and the wall of the ICA was reconstructed. Postoperative three-dimensional CT scanning and MR angiography demonstrated disappearance of the aneurysm and preservation of the ICA. The patient was discharged without additional neurological deficits. Many complications, including IVH, are associated with removal of a ventricular catheter. This case shows that pseudoaneurysm formation can occur in a remote region due to avulsion of the AChA from the ICA. In most circumstances a ventricular catheter can be removed without difficulty. However, precision and caution should be exercised when removing a ventricular catheter.