Ruptured Bilateral Pericallosal Artery Aneurysm in Mirror Position: Case Report

Abstract

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult.

Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position.

Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts.

Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

Resumo

Introdução Os aneurismas de artéria pericalosa (AP) representam 2 a 9% de todos os aneurismas e seu manejo permanece difícil.

Objetivo O objetivo do presente estudo é descrever o caso de uma mulher adulta com hemorragia subaracnóidea e aneurisma bilateral de AP em posição de espelho.

Relato do Caso Uma mulher de 46 anos foi encaminhada para nossa instituição 20 dias após dor de cabeça severa repentina. Ela informou que estava tratando sua hipertensão arterial de forma irregular e consumia 20 cigarros / dia. A paciente estava neurologicamente intacta na admissão. A tomografia computadorizada (TC) sem contraste no primeiro dia do início dos sintomas revelaram hidrocefalia e hemorragia subaracnóidea (Fisher III). Uma Angiotomografia de crânio e arteriografia por subtração digital mostraram aneurismas bilaterais de AP em espelho. O paciente foi tratado com sucesso por meio de cirurgia através de acesso inter-hemisférico pela direita (pois o cirurgião é destro); o cirurgião realizou o controle proximal com clipagem temporária e introduziu dreno ventricular externo no final da cirurgia. A paciente recebeu alta no quarto dia de pós-operatório sem déficits neurológicos adicionais ou shunts ventriculares.

Conclusão O aneurisma de AP roto é um aneurisma cirurgicamente desafiador devido às muitas nuances anatômicas e risco de ressangramento. No entanto, o manejo cirúrgico de aneurismas de AP bilateral roto é viável e eficaz.

Keyword

pericallosal artery aneurysms

Palavra-chave

aneurisma de arteria pericalosa

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