title: Reconstructive Endovascular Treatment of an Intracranial Infectious Aneurysm in Bacterial Meningitis: A Case Report and Review of Literature.
abstract: BACKGROUND
  Intracranial infectious aneurysms (IAs) are rare cerebrovascular lesions that represent only 1%-6% of all intracranial aneurysms. IAs are rare cerebrovascular lesions and pose a significant therapeutic challenge because of their angiographic and pathophysiologic features. We describe a patient with an intracranial IA treated by the use of reconstructive endovascular methods using a balloon-expandable covered stent and discuss the pathophysiologic characteristics of IA based on serial brain imaging findings.
  
  
  METHODS
  A 21-year-old man was admitted to our emergency department with headache and vomiting. Neurologic examination, hematologic workup, and cerebrospinal fluid examination confirmed a diagnosis of bacterial meningitis. Initial brain magnetic resonance angiography revealed no significant stenosis lesions or aneurysm. After 4 weeks of antibiotic treatment, follow-up brain magnetic resonance imaging revealed an 8-mm sized aneurysm on the petrous portion of the right internal carotid artery, and 3 months later, follow-up brain magnetic resonance angiography revealed that the aneurysm had increased in size from 8 to 15 mm. Conventional 4-vessel angiography confirmed the presence of a pseudoaneurysm. Endovascular treatment was then planned via the use of a balloon-expandable covered stent. Postoperatively, the patient was discharged without specific neurologic deficit.
  
  
  CONCLUSIONS
  IAs are rare cerebrovascular lesions and pose a significant therapeutic challenge because of their angiographic and pathophysiologic features. Although endovascular treatment is not performed routinely for infectious aneurysms, the covered stent may represent a safe and effective treatment that achieves complete endoluminal reconstruction of the damaged vessel wall.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Moon-Soo
authors.initials: MS
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Tae-Sun
authors.initials: TS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea. Electronic address: nsjsp@jnu.ac.kr.
authors.forename: Sung-Pil
authors.initials: SP
authors.lastname: Joo
mesh_terms: D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D007710:Klebsiella Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D008297:Male; D016920:Meningitis, Bacterial / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endovascular treatment; Infectious aneurysm; Mycotic aneurysm; Stent graft