Iatrogenic pseudoaneurysms associated with cerebrospinal fluid diversion procedures

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neuroradiology

Background:

• Cerebrospinal fluid diversion procedures like ventriculoperitoneal (VP) shunts are standard for hydrocephalus.
• Common complications include obstruction, infection, and hemorrhage.
• Pseudoaneurysm formation from catheter insertion is rare, typically involving anterior cerebral or external carotid artery branches.

Observation:

• A 36-year-old female developed a fusiform pseudoaneurysm from a middle cerebral artery branch post-VP shunt insertion.
• Hemorrhage occurred 15 days postoperatively at the catheter insertion site.
• The VP shunt was removed, and the pseudoaneurysm was occluded; limited dural opening may have contributed.

Findings:

• This case highlights a rare iatrogenic pseudoaneurysm originating from the middle cerebral artery.
• The pseudoaneurysm was associated with parenchymal and intraventricular hemorrhage.
• Successful management involved shunt removal and aneurysm occlusion.

Implications:

• Careful consideration of vascular anatomy during shunt planning is essential.
• A cruciate dural opening may aid visualization and prevent complications.
• Early diagnosis and treatment of iatrogenic pseudoaneurysms are critical to avoid re-bleeding and further hemorrhage.