Different modalities of treatment of intracranial mycotic aneurysms: Report of 4 cases.
BACKGROUND
Intracranial mycotic aneurysms, although rare neurovascular pathology, represented a neurosurgical challenge that required careful stepwise decision making. Different approaches for their management were used. We present our experience with 4 patients treated in terms of indications and efficacy of different treatment modalities.


METHODS
Four patients with infective endocarditis and 5 intracranial mycotic aneurysms were treated during the last 5 years. All of the patients were men; their ages ranged between 29 and 62 years (mean, 47.3 years). Distal MCA was the commonest site (3 patients) of aneurysm, 1 was located at the distal PCA, whereas the remaining aneurysm was at the distal ACA. Angiographic studies were done in 2 patients because of neurologic signs and for screening in 2 patients with documented endocarditis.


RESULTS
One patient was treated conservatively because of his moribund general condition; 1 patient was treated with direct surgical clipping; 1 patient was treated with surgical trapping and resection of the aneurysm without revascularization; and the remaining patient, harboring 2 distal mycotic aneurysms, was treated with selective embolization for his PCA aneurysm and endovascular trapping for the distal ACA aneurysm. Follow-up angiographic results showed stable occlusion of the aneurysms. No periprocedural technical complications were reported, and none of the patients, including the patient with medical treatment only, has ever experienced new neurologic events after definitive treatment.


CONCLUSIONS
Prolonged courses of antibiotics are recommended for all patients with mycotic aneurysms. Selective endovascular embolization or trapping with soft and ultrasoft electrolytically detachable coils seems to be an effective technique that should be considered for treatment of dynamic unruptured mycotic aneurysms, with conventional surgical repair restricted for ruptured aneurysms with associated hematoma and high intracranial pressure.
Nakahara
Ichiro
I
Department of Neurosurgery, Kokura Memorial Hospital, Kitakyusyu-shi Fukuoka, 802-8555, Japan. ichiro@mub.biglobe.ne.jp
Taha
Mahmoud M
MM
Higashi
Toshio
T
Iwamuro
Yasushi
Y
Iwaasa
Mitsutoshi
M
Watanabe
Yoshihiko
Y
Tsunetoshi
Kenzo
K
Munemitsu
Toshihiro
T
D000328:Adult; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods / Q000592:standards; D004697:Endocarditis, Bacterial / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy*; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods / Q000592:standards