[A case of multiple cerebral mycotic aneurysms treated with endovascular surgery]

A case of multiple mycotic cerebral aneurysms successfully treated with endovascular surgery is reported. A nine-year-old boy who has suffered from hypertrophic obstructive cardiomyopathy and active infectious endocarditis in the mitral valve developed sudden consciousness disturbance and convulsion. Computerized tomography revealed subarachnoid hemorrhage with subcortical hematoma in the left parietal lobe. Angiography demonstrated four aneurysms at the distal part of the middle cerebral artery on both sides. Since his physical status had been deteriorating, it was difficult to undergo a usual surgical operation. Therefore, endovascular surgery was performed. The catheter was super-selectively advanced to the parent artery of the left posterior parietal artery aneurysm which seemed to be the hemorrhagic source, and the embolization was performed using platinum coils and liquid embolization material. Angiography after embolization showed that the aneurysms had been successfully occupied by the materials while the aneurysm of the right anterior parietal artery had not responded antibiotic therapy. Therefore the second embolization was carried out to the parent artery of the aneurysm of the right anterior parietal artery one month later. The patient had no neurological deficit after embolization and no aneurysms have been detected by the follow-up angiogram after the second embolization. An endovascular approach might be an alternative useful treatment for cases in which the patient has, deteriorated so much that it is considered difficult to perform open craniotomy under general anesthesia.