Traumatic intracranial aneurysms caused by missiles: their presentation and management

Only 30 cases of traumatic intracranial aneurysm (TICA) secondary to missile injury have been reported to date. To these we add 15 more cases. Missile TICAs are often seen on a secondary branch of the middle cerebral artery and are usually accompanied by a intracerebral hematoma (80%) or by an acute subdural hematoma (26%). Fourteen of our cases were secondary to shrapnel injuries and only one was secondary to a bullet. None of the injuries was through-and-through. TICAs may enlarge in time and, seemingly inoffensive, may rupture and lead to death. All seven TICAs studied histologically proved to be false aneurysms. TICAs are best treated through trapping and excision. The outcome depends on the patient's status and level of consciousness before surgery. Indications for angiography are discussed.