Treatment Strategy for Infectious Intracranial Aneurysms in the Era of Interventional Neuroradiology

Abstract

Objective: Aggressive therapeutic intervention is recommended for infectious intracranial aneurysms (IIAs) because they have a higher hemorrhage risk than non-IIAs. In this study, we retrospectively reviewed patients with IIAs treated at our institution and evaluated the contents of treatment and the complications. Results: Endovascular treatment, direct surgery, and conservative management were performed in five, five, and three patients, respectively. In endovascular treatment patients, none developed any hemorrhagic or infectious complications.In the five direct surgery patients, we selected direct surgery because three patients needed hematoma evacuation, and the catheter navigation was not achievable in the remaining two patients. Conclusion:Since IIAs often occur in peripheral arteries and are accompanied by local infection, aneurysmectomy by direct surgery used to be preferred. However, as embolization of cortical branches using a flexible catheter and small coils has become technically possible by the improvements of endovascular devices, endovascular parent artery occlusion might be a reasonable alternative for IIAs.

Differentiating between Mycotic and Dissecting Aneurysms in a Case of Ruptured Distal Superior Cerebral Artery Aneurysm

“…2) Many reports suggested that endovascular treatment does not cause complications including infection. 15) The pearl-and-string sign can be a tool for making the diagnosis. Nevertheless, the imaging of both diseases shows various types of aneurysm and it is difficult to make the diagnosis using only imaging.…”

“… 14) Regarding treatment for aneurysms include surgical trapping, clipping, and endovascular coiling and trapping. 1 , 15) Endovascular surgery has become an important treatment for mycotic aneurysm. Many patients with deteriorating conditions and those who have vegetations and require cardiothoracic surgery have been treated with endovascular surgery.…”

“… 2) Many reports suggested that endovascular treatment does not cause complications including infection. 15) …”