title: Management of Ruptured and Rapidly Progressive Mycotic Cerebral Aneurysms in the Setting of Unilateral Carotid Occlusion and Endocarditis with Valve Failure.
abstract: Mycotic cerebral aneurysms can present unique neurosurgical challenges. We report a patient with left carotid occlusions, a ruptured left middle cerebral artery mycotic aneurysm, and a rapidly appearing unruptured left anterior cerebral artery/anterior communicating artery (ACA/ACom) mycotic aneurysm in the setting of mitral valve endocarditis with a perivalvular leak and evolving congestive heart failure. Following medical stabilization and antibiotic administration, a combined endovascular (with contralateral access via the ACom) and open surgical approach was used to selectively secure both aneurysms with preservation of distal flow, allowing lifesaving cardiac valve replacement. This case illustrates the therapeutic complexity of mycotic cerebral aneurysms, which we discuss in the context of an increasing reliance on endovascular approaches.
authors.affiliation: Division of Neurosurgery, University of California, San Diego, San Diego, California, United States.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Rennert
authors.affiliation: Division of Neurosurgery, University of California, San Diego, San Diego, California, United States.
authors.forename: David R
authors.initials: DR
authors.lastname: Santiago-Dieppa
authors.affiliation: Division of Neurosurgery, University of California, San Diego, San Diego, California, United States.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Pannell
authors.affiliation: Division of Neurosurgery, University of California, San Diego, San Diego, California, United States.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Khalessi
keywords: anterior communicating artery aneurysm; endovascular treatment; microneurosurgical treatment; middle cerebral artery bifurcation aneurysm; mycotic aneurysm