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[Management strategy for infectious cerebral aneurysms: report of four cases]
Akio Soeda1, Nobuyuki Sakai, Kenichi Murao
1Department of Neurosurgery, Chubu-Ryougo Center, Kizawa-Memorial Hospital, 630 Shimokobi-Kobichou, Minokamo-city, Gifu 505-0034, Japan.
Insights
This study reports on four patients with infectious cerebral aneurysms linked to infective endocarditis. Treatment varied, with surgical and endovascular approaches discussed for managing these complex neurological conditions.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Infective endocarditis can lead to infectious cerebral aneurysms, a rare but serious complication.
- Management strategies for these aneurysms are not standardized and require careful consideration.
Observation:
- Four patients with infectious cerebral aneurysms associated with infective endocarditis were treated surgically and/or via endovascular methods.
- Two patients presented with intracerebral hemorrhage, managed with surgery or endovascular techniques based on hematoma size.
- Two patients had unruptured aneurysms; one treated with endovascular parent-artery occlusion, the other initially with antibiotics followed by rupture post-cardiac surgery.
Findings:
- Surgical and endovascular interventions were employed for hemorrhage control and aneurysm treatment.
- One patient treated conservatively with antibiotics experienced delayed rupture after cardiac surgery, leading to a poor outcome.
- Outcomes varied, highlighting the challenges in managing infectious cerebral aneurysms.
Implications:
- Optimal management of infectious cerebral aneurysms requires a tailored approach based on aneurysm characteristics and patient presentation.
- Early diagnosis and intervention are crucial for improving patient outcomes.
- Further research is needed to establish definitive treatment guidelines for these complex vascular lesions.
Abstract:
The surgical and/or endovascular treatment of four patients with infectious cerebral aneurysm associated with infective endocarditis was reported. Two patients presented with intracerebral hemorrhage. One of them, with large hematoma, was treated surgically and the other, with small hematoma, was treated by endovascular surgery. The third patient, with unruptured aneurysm of the distal anterior cerebral artery, was treated by endovascular parent-artery occlusion without neurological deterioration. The fourth patient, with unruptured aneurysm of the distal middle cerebral artery, was initially treated with antibiotics, resulting in stabilization of the aneurysm. However, three weeks after open heart surgery, the aneurysm ruptured, causing a large cerebral hematoma. Despite prompt evacuation of the hematoma and surgical resection of the aneurysm, this patient remained in a vegetative state. Management strategy of intracranial infective aneurysms is discussed.