Saccular aneurysm with basal rupture angiographically depicted as an aneurysm with stalk-like narrow neck

Report of 2 cases

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On occasion, the wall of the aneurysm base can be the rupture site of the lesion, which poses a unique challenge for treatment. Although there has already been a report of the angiographic depiction of a basal rupture of a saccular aneurysm by a small outpouching at the aneurysm neck, this is the first report of saccular aneurysms in which a basal rupture was angiographically depicted as a stalk-like narrow neck due to a thrombus sealing the rupture point and occupying the lumen of the aneurysm base. The author reports on 2 such cases: a 49-year-old woman who presented with a basal rupture of a saccular aneurysm arising at the middle cerebral artery bifurcation, and a 44-year-old man who presented with rupture of a saccular aneurysm arising at the junction of the A2 segment and the anterior communicating artery. In both cases, a pterional craniotomy allowed the surgeon to determine that the base of the aneurysm was ruptured, and he surgically obliterated the aneurysm. Microsuture reconstruction and clipping of the aneurysm neck were successful in obliterating the ruptured aneurysm and avoiding any compromise of the parent artery.

Abbreviations used in this paper: ACoA = anterior communicating artery; CA = carotid artery; MCA = middle cerebral artery.

Article Information

Address correspondence to: Jaechan Park, M.D., Department of Neurosurgery, Kyungpook National University Hospital, 50, Samduk 2-ga, Jung-gu, Daegu, South Korea 700-721. email: jparkmd@hotmail.com.

Please include this information when citing this paper: published online June 25, 2010; DOI: 10.3171/2010.6.JNS1086.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. A and B: Preoperative right CA angiogram and CT angiogram showing a 4-mm saccular aneurysm attached to the bifurcation of the right MCA by a stalk-like tubular narrow neck (arrows). C: Left CA angiogram revealing an ordinary narrow-necked aneurysm at the left MCA bifurcation.

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    Case 1. Intraoperative photographs (right pterional craniotomy [A–E] and left pterional craniotomy [F]). A: Right MCA bifurcation aneurysm with a thrombus sealing the rupture site. B: Corresponding illustration. C: Basal rupture (arrow) clarified after aneurysm dissection. D: Placement of two 10-0 nylon suture stitches at the rupture site of the aneurysm neck. E: Final clipping of the aneurysm. F: Typical unruptured saccular aneurysm at the left MCA bifurcation.

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    Case 2. Preoperative catheter-based angiogram (left) and CT angiogram (right) revealing a forward-projecting 4-mm saccular aneurysm attached to the junction of the left A2 and ACoA by a stalk-like narrow neck (arrows).

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    Case 2. Intraoperative photographs. A: Basal rupture clarified after dissecting the ACoA aneurysm. B: Corresponding illustration. C: Aneurysm clipping after placing a 10-0 nylon suture stitch at the rupture site of the aneurysm neck.

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