title: Treatment Strategy Based on Experience of Treating Intracranial Infectious Aneurysms.
abstract: OBJECTIVE
  Intracranial infectious aneurysms (IIAs) are a rare but unique subtype of potentially life-threatening vascular lesion. However, there is no widely accepted standard protocol for their management. We reviewed our treatment experiences of IIAs from 2001 to 2015 and proposed a treatment strategy for future use.
  
  
  METHODS
  We retrospectively reviewed 25 patients with 33 IIAs. All patients had predisposing infectious disease for which the causative organism had been identified.
  
  
  RESULTS
  There were 12 patients with ruptured IIAs and 13 with unruptured IIAs. Of these patients, 17 (68%) had infective endocarditis, and viridans group streptococci (40%) were the most common causative organisms. All patients underwent antibiotic therapy, and 17 IIAs in 13 patients resolved with intravenous antibiotic therapy. However, 16 IIAs in 12 patients required neurosurgical treatment, including parent artery occlusion with glue or coils, endosaccular coiling, or microsurgery. The mean size of IIAs that responded to intravenous antibiotics (4.1 ± 2.2 mm) was smaller than that for IIAs with no response (7.5 ± 3.1 mm) (P = 0.01). Two patients had treatment-related complications: an acute cerebral infarction after parent artery occlusion and a rupture of the IIA during antibiotic therapy. There was no recurrence or mortality.
  
  
  CONCLUSIONS
  All patients with IIAs should undergo appropriate antibiotic therapy. In cases with unruptured IIA, patients can be managed using medical therapy with antibiotics alone for 4-6 weeks. However, neurosurgical treatment should be considered in cases of ruptured IIA or unruptured IIA that do not respond to antibiotic therapy.
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical center, Seoul, Korea. Electronic address: elevenes@gmail.com.
authors.forename: Wonhyoung
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical center, Seoul, Korea.
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical center, Seoul, Korea.
authors.forename: Jung Cheol
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical center, Seoul, Korea.
authors.forename: Byung Duk
authors.initials: BD
authors.lastname: Kwun
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical center, Seoul, Korea.
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Antibiotics; Endovascular procedures; Infected; Intracranial aneurysm; Microsurgery; Mycotic