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Aspergillotic aneurysm formation of cerebral artery following neurosurgical operation
1Department of Neurosurgery, Tokyo Women's Medical College, Japan.
Abstract:
A rare case of intracranial aspergillotic aneurysm following neurosurgical operation for facial spasm is presented. Severe meningitis had persisted several days prior to the subarachnoid hemorrhage which occurred on 70th postoperative day. Angiography demonstrated a fusiform aneurysm at the peduncular segment of the superior cerebellar artery on the other side of operation. As the repeated cultures of CSF were negative, the pathogenetic factor causing aneurysm formation could not be identified before second operation of aneurysmal resection. Pathological study of the specimen revealed the arterial wall being deeply invaded by aspergillotic hyphae.
Insights
A rare intracranial aspergillotic aneurysm developed after facial spasm surgery. Fungal invasion of the artery wall was confirmed during aneurysm resection, explaining the complication.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Vascular Neurology
Background:
- Intracranial aneurysms can arise from various causes, including infections.
- Fungal infections, particularly Aspergillus, pose a rare but serious threat in neurosurgical contexts.
- Postoperative complications require vigilant diagnosis and management.
Observation:
- A patient developed a fusiform aneurysm of the superior cerebellar artery 70 days after surgery for facial spasm.
- The patient experienced persistent meningitis prior to subarachnoid hemorrhage.
- Cerebrospinal fluid cultures were repeatedly negative, delaying diagnosis.
Findings:
- Angiography revealed a fusiform aneurysm at the superior cerebellar artery's peduncular segment.
- Pathological examination of the resected aneurysm showed deep invasion by Aspergillus hyphae.
- This confirmed an intracranial aspergillotic aneurysm as the cause.
Implications:
- This case highlights the potential for delayed fungal infections to cause vascular complications after neurosurgery.
- Negative CSF cultures do not exclude fungal etiology in suspected postoperative meningitis or aneurysm formation.
- Early recognition and aggressive antifungal treatment are crucial for managing such rare but devastating conditions.