title: Importance of repeat angiography in the diagnosis of iatrogenic anterior cerebral artery territory pseudoaneurysm following endoscopic sinus surgery.
abstract: Iatrogenic intracranial pseudoaneurysm formation and rupture are rare complications following endoscopic sinus surgery. Given the propensity for devastating neurologic injury after a relatively routine procedure, swift diagnosis and treatment is essential. The authors present a patient who experienced bifrontal intracranial hemorrhage and subarachnoid hemorrhage due to a ruptured iatrogenic frontopolar artery pseudoaneurysm caused during routine endoscopic sinus surgery. The pseudoaneurysm was not present on initial angiograms but became apparent radiographically 19 days after the endoscopic procedure. Endovascular treatment consisted of coil and Onyx embolization for sacrifice of the parent vessel proximal to the lesion. Early recognition of iatrogenic intracranial vascular injury is important to allow for rapid treatment. Initial radiographic studies may be unreliable in excluding the presence of a pseudoaneurysm so delayed repeat angiographic assessment is necessary, particularly in the presence of a high index of clinical suspicion. Endovascular techniques may provide an effective and safe option for the treatment of iatrogenic anterior cerebral artery distribution pseudoaneurysms.
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Munich
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA.
authors.forename: Marshall C
authors.initials: MC
authors.lastname: Cress
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA.
authors.forename: Chandan
authors.initials: C
authors.lastname: Krishna
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging*; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D004724:Endoscopy / Q000009:adverse effects; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014700:Verapamil / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D014700:Verapamil
keywords: Aneurysm; Angiography; Artery; Hemorrhage