Evolution and resolution of intracranial bacterial (mycotic) aneurysms

Surgical therapy of bacterial intracranial aneurysms may prove difficult when multiple aneurysms are present or lesions are proximally located. Two patients underwent operation for bacterial intracranial aneurysms without resolution of their problems, in one case because of the involvement of a proximal branch of a dominant middle cerebral artery and in the other because of the presence of multiple bilateral aneurysms. Both patients underwent multiple angiographic evaluations during the course of treatment with documentation of complete resolution of their aneurysms over many months. The time course of the evolution and resolution of the bacterial intracranial aneurysms identified in the two patients is described, and antibiotic therapy and cardiac surgery are discussed.