Development and rupture of a de novo basilar artery aneurysm after surgical removal of a cerebellar arteriovenous malformation.
BACKGROUND
The de novo development of an aneurysm in an previously normal artery is an uncommon event. We describe a patient who developed a de novo bleeding aneurysm of the basilar artery in the three weeks following the surgical removal of a large cerebellar AVM. METHOD-FINDINGS: A 48-year-old man suddenly developed transient headache, vertigo and disturbance of balance. Neuroradiological examinations showed the presence of a large AVM of the right cerebellar hemisphere. The AVM was removed successfully; following the operation there were repeated bleeding episodes at the operating site, requiring surgical evacuation. Three weeks after the AVM removal he suffered from a massive subarachnoid haemorrhage due to the rupture of an aneurysm developed de novo in the basilar artery.


CONCLUSIONS
This is the first reported case, to our knowledge, of a de novo aneurysm developed in an artery hemodynamically related to a surgically removed AVM. This complication was probably due to the postoperative hemodynamic changes in the vessels afferent to the AVM, associated with arterial wall dysplasia.
Brock
S
S
Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milan, Italy. neurochirurgia@istituto-besta.it
Giombini
S
S
Ciceri
E
E
D015901:Angiography, Digital Subtraction; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery*; D002531:Cerebellum / Q000098:blood supply*; D002533:Cerebral Angiography; D003399:Craniotomy; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012086:Reoperation; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology; D017287:Ventriculoperitoneal Shunt