Giant posterior communicating artery aneurysm presenting as third ventricle mass with obstructive hydrocephalus

Abstract

The case of a giant posterior communicating artery (PCoA) aneurysm is reported in which the initial presentation was coma secondary to obstructive hydrocephalus. The primary radiological diagnosis was a probable craniopharyngioma. A cerebral angiogram revealed a partially thrombosed giant PCoA aneurysm on the right side. The patient underwent pterional craniotomy with aneurysm clipping and thrombectomy to relieve mass effect, and has made a good recovery. Review of the literature documents that giant PCoA aneurysms are rare. This is believed to be the first reported case of a PCoA aneurysm presenting as a third ventricle mass with obstructive hydrocephalus. The magnetic resonance imaging characteristics of those third ventricle masses that mandate vascular workup are discussed.

An Unusual Case of a Thrombosed Giant Distal PICA Aneurysm Simulating a Large Cavernous Angioma

“…Giant aneurysms usually present clinically as spaceoccupying lesions and differ from the presentation of the common and medium-sized aneurysms 6,19) . Thus, giant intracranial aneurysms may occasionally be mistaken for tumors 2,3,5,7,21) . Giant aneurysms typically appear on computerized tomography (CT) as rounded or oval-shaped masses with distinct outlines.…”

Basilar Apex Aneurysm Manifesting as Third Ventricular Mass and Obstructive Hydrocephalus -Case Report-

“…On the other hand, however, a rare case of thrombosed giant posterior communicating artery aneurysm has been described that presented as third ventricular mass, causing obstructive hydrocephalus, and was successfully treated with clip obliteration and thrombectomy alone. 14) We should be aware that CSF diversion may carry the risk of inducing aneurysm growth resulting in devastating clinical sequelae. 5,6) For example, there was a case report that a patient with dissecting basilar artery aneurysm was initially treated conservatively, showed transient clinical improvement after VP shunting, but suffered aneurysm rupture one month after the surgery.…”

Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements

“…MRI taken after resolution of IVH usually shows the site of the aneurysm clearly, precise location within the ventricle and the relation of the lesion to the parent vessel (Smith et al, 1994). The aneurysm usually appeared as flow void signs with marked gadolinium enhancement (Fig.1).…”

“…Cross-sectional imaging modalities can usually be used to distinguish aneurysms from other mass lesions (Smith et al, 1994). Initially, a correct preoperative diagnosis is vital, and the wrong diagnosis of an aneurysm in an unusual location may encourage surgical removal of these lesions (Bose et al, 1983;Liu et al, 2005).…”