Stereotactic angiographic localization as an adjunct to surgery of cerebral mycotic aneurysms: Case report and review of the literature

Abstract

Less than 10% of all aneurysms affecting the arterial cerebral circulation are mycotic in nature. They occur in the setting of bacterial endocarditis and are the cause of considerable morbidity and mortality of affected patients. In selected cases surgery may play a curative role in the treatment plan. These aneurysms frequently arise in distal arterial branches, and their localization during surgery may at times prove laborious. We report the case of a mycotic aneurysm of a distal branch of the anterior cerebral artery surgically treated with the help of angiographic stereotactic localization. Stereotaxy should thus be regarded as a pertinent adjunct in selected cases of surgical treatment of distal mycotic cerebral aneurysms.

Endovascular Treatment of Cerebral Mycotic Aneurysms

“…A distal aneurysm can sometimes be missed with a surgical approach (21), so stereotaxy has been recommended (23,24). The risks of surgery are greater for patients with large, multiple, or ruptured MAs and for patients with MAs located in highly functional areas (3,22,25).…”

Endovascular Treatment for a Unusually Large Mycotic Aneurysm Manifesting as Intracerebral Hemorrhage-Case Report-

“…Some authors recommend stereotaxic surgery for distally located aneurysms. 2,8,19) However, our patient had hypotension refractory to high-dose catecholamine, so that open surgery under general anesthesia carried unpredictable risks. Therefore, we decided to occlude the aneurysm and the parent artery with endovascular coils under local anesthesia.…”