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Intracerebral hemorrhage from a ruptured pseudoaneurysm after STA-MCA anastomosis--case report
S Nishizawa1, T Yokoyama, K Sugiyama
1Department of Neurosurgery, Hamamatsu University School of Medicine, Shizuoka.
Abstract:
A 43-year-old hypertensive male developed a pseudoaneurysm at the site of a superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, causing massive intracerebral hemorrhage 5 years after the operation. He first experienced repeated transient ischemic attacks, and cerebral angiography disclosed complete occlusion in the cervical portion of the left internal carotid artery. STA-MCA anastomosis was performed, and the ischemic attacks stopped. Postoperative angiography confirmed patency of the anastomosis and good filling of the cortical branches of the left MCA. Five years after surgery, the patient suffered sudden onset of generalized convulsions and consciousness disturbance. Computed tomography disclosed a massive intracerebral hemorrhage in the left frontoparietal region, and angiography revealed an aneurysmal dilatation at the site of the anastomosis that was not seen before. Emergency evacuation of the hematoma and clipping of the aneurysmal dilatation were performed. The patient recovered well and became ambulatory. Histological examination of the surgical specimen showed collagen tissue, indicating a pseudoaneurysm. Patients who undergo STA-MCA anastomosis, especially hypertensive patients, should be followed up by repeated magnetic resonance angiography to confirm the patency of the anastomosis and cerebral perfusion, and to detect the formation of pseudoaneurysms at the anastomosis site, which can cause fatal bleeding.
Insights
A superficial temporal artery-middle cerebral artery bypass can lead to pseudoaneurysm formation, causing severe bleeding years later. Regular monitoring is crucial for patients, especially those with hypertension, to detect these dangerous complications.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is a surgical procedure to restore blood flow to the brain.
- Hypertension is a known risk factor for vascular complications.
Observation:
- A 43-year-old male with hypertension developed a pseudoaneurysm at the STA-MCA anastomosis site 5 years post-surgery.
- This pseudoaneurysm resulted in a massive intracerebral hemorrhage, presenting as seizures and altered consciousness.
Findings:
- The patient experienced transient ischemic attacks prior to the initial STA-MCA anastomosis due to internal carotid artery occlusion.
- Post-surgery, angiography confirmed successful bypass, but 5 years later, a new aneurysmal dilatation (pseudoaneurysm) was detected at the anastomosis site.
- Histological examination confirmed the presence of a pseudoaneurysm.
Implications:
- Patients undergoing STA-MCA anastomosis, particularly those with hypertension, require long-term surveillance.
- Regular magnetic resonance angiography is recommended to monitor anastomosis patency, cerebral perfusion, and detect potential pseudoaneurysm formation.
- Early detection and management of pseudoaneurysms are vital to prevent life-threatening hemorrhage.