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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
18:50

Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment

Published on: September 25, 2009

Flow-mediated pseudolesion mimicking an intracranial aneurysm secondary to cervical internal carotid artery

Feng Zeng1, Feng Wen2, Kaikai Fu1

  • 1Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai.

Journal of Neurosurgery. Case Lessons
|June 1, 2026
PubMed

Insights

Internal carotid artery dissection can create flow abnormalities that mimic intracranial aneurysms on angiography. Careful evaluation of cerebrovascular hemodynamics is crucial to avoid misdiagnosis and unnecessary surgery.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Diagnostic Imaging

Background:

  • Internal carotid artery dissection (ICAD) can cause hemodynamic changes.
  • These alterations may obscure the accurate identification of intracranial aneurysms.
  • Compromised angiographic assessment can impact treatment decisions.

Purpose of the Study:

  • To report a unique case of a pseudolesion mimicking an intracranial aneurysm.
  • To highlight the role of hemodynamic alterations in diagnostic misinterpretations.
  • To emphasize the importance of evaluating cerebrovascular flow dynamics.

Main Methods:

  • Digital subtraction angiography (DSA) was performed.
  • Focused angiography identified a cervical internal carotid artery dissection.
  • Endovascular stent placement was utilized for treatment.

Main Results:

  • Initial DSA suggested a supraclinoid ICA aneurysm.
  • Anomalous collateral circulation raised suspicion of proximal pathology.
  • Post-stent imaging revealed a hemodynamically distorted infundibulum, not an aneurysm.

Conclusions:

  • This is the first report of a flow-mediated pseudolesion mimicking an aneurysm due to ICAD.
  • Hemodynamic artifacts can lead to misinterpretations despite DSA being a gold standard.
  • Comprehensive assessment of cerebrovascular flow is vital to prevent diagnostic errors and unnecessary procedures.
Abstract

Keywords:
ICADUIAarterial infundibulumhemodynamically pseudolesioninternal carotid artery dissectionunruptured intracranial aneurysm

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