[A case of iatrogenic traumatic intracranial aneurysm]

A case of traumatic aneurysm due to an arterial injury during removal of a tuberculum sellae meningioma is reported. A 43-year-old man had undergone craniotomy for removal of the tumor. It was very hard with many feeders from bilateral anterior cerebral arteries (ACA), so the resection between the left ACA and the tumor was difficult. A small artery was accidentally pulled out from the left ACA and bleeding occurred from the small artery in the artery. The ACA was trapped temporarily with two clips and was coated using Oxycell and Biobond. The bleeding was stopped by this procedure and the blood reflowed. This tumor was removed totally, but postoperative CT scan showed an enhancing small lesion in the anterior part of the left basal ganglia 10 days after operation. The angiograms performed next day revealed a fusiform aneurysm of the left proximal ACA near the anterior communicating artery. The skull was reopened to treat the aneurysm. The aneurysm arising from just a bleeding point in the previous operation was oval in shape without neck, so it was trapped by two small aneurysm clips and resected. The patient's condition was uneventful after the second operation. Pathological diagnosis of the aneurysm was confirmed a false aneurysm. Iatrogenic traumatic aneurysms caused by neurosurgical procedure has been reported in 29 cases. Eighteen cases showed bleeding from injured artery during surgery and a half of them showed rupture from the aneurysm within one month after operation. Such doubtful cases of traumatic aneurysm should be diagnosed by angiography and operated as early as possible.