J A Alvarez1, N Bambakidis, Y Takaoka. 1. Department of Neurological Surgery, University Hospitals of Cleveland, Cleveland, Ohio, USA. jaime@excite.com
Abstract
BACKGROUND AND OBJECTIVES: Traumatic intracranial aneurysms (TICAs) are highly unstable lesions that may rupture within minutes after formation or remain quiescent for several weeks and manifest with delayed hemorrhage and neurologic deterioration. Mortality following a rupture may be 30% to 40%. Among all cerebral aneurysms, the incidence of TICAs is less than 1%; 20% to 30% of TICAs occur in children. METHODS AND MATERIALS: A child with a low-caliber craniocerebral gunshot wound deteriorated neurologically 12 days after the initial injury and emergency evacuation of an intracranial hematoma. A new massive left frontal hematoma was discovered, caused by the rupture of an unsuspected left pericallosal artery pseudoaneurysm. The new hematoma was evacuated, and the aneurysm was trapped using microsurgical techniques. RESULTS AND/OR CONCLUSIONS: A high index of suspicion should be maintained for delayed pseudoaneurysm genesis and rupture. A cerebral arteriogram should be obtained when significant subarachnoid hemorrhage or intraparenchymal hematomas are present, when missiles traverse major arteries, or when the pterional or cranioorbitofacial regions are violated. Treatment should be prompt.
BACKGROUND AND OBJECTIVES:Traumatic intracranial aneurysms (TICAs) are highly unstable lesions that may rupture within minutes after formation or remain quiescent for several weeks and manifest with delayed hemorrhage and neurologic deterioration. Mortality following a rupture may be 30% to 40%. Among all cerebral aneurysms, the incidence of TICAs is less than 1%; 20% to 30% of TICAs occur in children. METHODS AND MATERIALS: A child with a low-caliber craniocerebral gunshot wound deteriorated neurologically 12 days after the initial injury and emergency evacuation of an intracranial hematoma. A new massive left frontal hematoma was discovered, caused by the rupture of an unsuspected left pericallosal artery pseudoaneurysm. The new hematoma was evacuated, and the aneurysm was trapped using microsurgical techniques. RESULTS AND/OR CONCLUSIONS: A high index of suspicion should be maintained for delayed pseudoaneurysm genesis and rupture. A cerebral arteriogram should be obtained when significant subarachnoid hemorrhage or intraparenchymal hematomas are present, when missiles traverse major arteries, or when the pterional or cranioorbitofacial regions are violated. Treatment should be prompt.