Intraoperative Aneurysm Rupture during Resection for Presumed Metastasis

Area of Science:

• Neuro-oncology
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Metastatic melanoma frequently involves the brain, presenting diverse intracranial manifestations.
• Surgical resection of brain metastases can be complicated by unexpected vascular events.
• Fusiform aneurysms, particularly in the posterior cerebral artery, pose unique surgical challenges.

Observation:

• During elective surgery for presumed metastatic melanoma, a 54-year-old male patient experienced sudden, extensive intraoperative bleeding.
• An emergent cerebral angiogram identified a fusiform aneurysm of the left posterior cerebral artery as the source of hemorrhage.
• This unexpected finding necessitated immediate adaptation of the surgical and interventional strategy.

Findings:

• The patient underwent successful vessel sacrifice via coil embolization to manage the ruptured aneurysm.
• This intervention effectively controlled the bleeding and addressed the critical vascular complication.
• The case underscores the potential for rare vascular pathology to coexist with or be exacerbated by metastatic disease.

Implications:

• This case highlights the importance of a multidisciplinary approach in managing complex neurosurgical cases involving metastatic cancer.
• It emphasizes the need for preparedness for unexpected intraoperative findings, including vascular anomalies.
• Successful endovascular management of such aneurysms offers a viable alternative to open surgical repair in select cases.