Middle Cerebral Artery Pseudoaneurysm Formation Following Stereotactic Biopsy

Rayes, Mahmoud; Bahgat, Diaa; Kupsky, William J.; Mittal, Sandeep

doi:10.1017/s0317167100009513

Cited by 14 publications

(13 citation statements)

References 39 publications

(64 reference statements)

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“…Iatrogenic intracranial pseudoaneurysm formation has been associated with a variety of neurosurgical operations, including brain biopsy or carotid injury during transsphenoidal surgery 4 7 8. The reported cases outline a shared sequence of events; a penetrating intraparenchymal procedure results in occult arterial injury.…”

Section: Discussionmentioning

confidence: 99%

Republished: Intracranial pseudoaneurysm after intracranial pressure monitor placement

Shah

Jones

Arnold

et al. 2014

J NeuroIntervent Surg

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SUMMARYTraumatic intracranial pseudoaneurysms are a rare but severe complication following arterial injury. Pseudoaneurysm formation can occur secondary to blunt or penetrating trauma or iatrogenic injury. We report a case of traumatic pseudoaneurysm secondary to placement of an intracranial pressure (ICP) monitor. A 27-year-old man was involved in a motorcycle accident resulting in multiple intracranial hemorrhages. The patient underwent craniectomy and placement of an ICP monitor. 17 days later he developed dilation of his left pupil, with imaging demonstrating a new hemorrhage in the vicinity of the previous ICP monitor. A cerebral angiogram confirmed a left-sided distal M4 pseudoaneurysm which was treated by n-butyl cyanoacrylate embolization. Intracranial pseudoaneurysm formation following neurosurgical procedures is uncommon. Delayed intracranial hemorrhage in a region of prior intracranial manipulation, even following a procedure as 'routine' as placement of an ICP monitor, should raise the suspicion for this rare but potentially lethal complication. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

Republished: Intracranial pseudoaneurysm after intracranial pressure monitor placement

Shah

Jones

Arnold

et al. 2014

J NeuroIntervent Surg

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“…1 3 Histologically, these lesions are characterized by complete interruption of the vessel wall with intravascular blood retained by an extravascular hematoma. 4 Intracranial pseudoaneurysms can develop following blunt or penetrating trauma, with the latter being more common. [1][2][3][4][5] Blunt trauma often results in pseudoaneurysm formation in stereotypical locations where shear forces can result in vessel injury.…”

Section: Discussionmentioning

confidence: 99%

“…4 Intracranial pseudoaneurysms can develop following blunt or penetrating trauma, with the latter being more common. [1][2][3][4][5] Blunt trauma often results in pseudoaneurysm formation in stereotypical locations where shear forces can result in vessel injury. 6 Pseudoaneurysms following penetrating trauma encompass a more heterogenous distribution and include iatrogenic causes.…”

Section: Discussionmentioning

confidence: 99%

Intracranial pseudoaneurysm after intracranial pressure monitor placement

et al. 2014

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Traumatic intracranial pseudoaneurysms are a rare but severe complication following arterial injury. Pseudoaneurysm formation can occur secondary to blunt or penetrating trauma or iatrogenic injury. We report a case of traumatic pseudoaneurysm secondary to placement of an intracranial pressure (ICP) monitor. A 27-year-old man was involved in a motorcycle accident resulting in multiple intracranial hemorrhages. The patient underwent craniectomy and placement of an ICP monitor. 17 days later he developed dilation of his left pupil, with imaging demonstrating a new hemorrhage in the vicinity of the previous ICP monitor. A cerebral angiogram confirmed a left-sided distal M4 pseudoaneurysm which was treated by n-butyl cyanoacrylate embolization. Intracranial pseudoaneurysm formation following neurosurgical procedures is uncommon. Delayed intracranial hemorrhage in a region of prior intracranial manipulation, even following a procedure as 'routine' as placement of an ICP monitor, should raise the suspicion for this rare but potentially lethal complication.

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“…Rare instances of iatrogenic pseudoaneurysm have been reported following stereotactic procedures. [48]…”

Section: Attention To Detailmentioning

confidence: 99%

Pitfalls in precision stereotactic surgery

Zrinzo

2012

Surg Neurol Int

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Precision is the ultimate aim of stereotactic technique. Demands on stereotactic precision reach a pinnacle in stereotactic functional neurosurgery. Pitfalls are best avoided by possessing in-depth knowledge of the techniques employed and the equipment used. The engineering principles of arc-centered stereotactic frames maximize surgical precision at the target, irrespective of the surgical trajectory, and provide the greatest degree of surgical precision in current clinical practice. Stereotactic magnetic resonance imaging (MRI) provides a method of visualizing intracranial structures and fiducial markers on the same image without introducing significant errors during an image fusion process. Although image distortion may potentially limit the utility of stereotactic MRI, near-complete distortion correction can be reliably achieved with modern machines. Precision is dependent on minimizing errors at every step of the stereotactic procedure. These steps are considered in turn and include frame application, image acquisition, image manipulation, surgical planning of target and trajectory, patient positioning and the surgical procedure itself. Audit is essential to monitor and improve performance in clinical practice. The level of stereotactic precision is best analyzed by routine postoperative stereotactic MRI. This allows the stereotactic and anatomical location of the intervention to be compared with the anatomy and coordinates of the intended target, avoiding significant image fusion errors.

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Middle Cerebral Artery Pseudoaneurysm Formation Following Stereotactic Biopsy

Cited by 14 publications

References 39 publications

Republished: Intracranial pseudoaneurysm after intracranial pressure monitor placement

Republished: Intracranial pseudoaneurysm after intracranial pressure monitor placement

Intracranial pseudoaneurysm after intracranial pressure monitor placement

Pitfalls in precision stereotactic surgery

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