title: Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review.
abstract: Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH. Conclusions Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.
authors.affiliation: 1 Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan.|2 Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nomura
authors.affiliation: 2 Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
authors.affiliation: 2 Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tamase
authors.affiliation: 2 Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kamide
authors.affiliation: 2 Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Seki
authors.affiliation: 2 Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Iida
authors.affiliation: 3 Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Tatsu
authors.initials: T
authors.lastname: Nakano
authors.affiliation: 3 Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kawabata
authors.affiliation: 4 Department of Radiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Kitabatake
authors.affiliation: 4 Department of Radiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: 4 Department of Radiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Yasutake
authors.affiliation: 4 Department of Radiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Egami
authors.affiliation: 4 Department of Radiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: 4 Department of Radiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Mitsuyuki
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: 5 Department of Pathology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Yanagimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000072226:Computed Tomography Angiography; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged
keywords: Pseudoaneurysm; cerebral aneurysm; intracerebral hematoma; subarachnoid hemorrhage