Surgical Outcome of Infectious Cerebral Aneurysms

Choi, Gwi Hyun; Lee, Jae Whan; Jung, Jin Young; Huh, Seung Kon; Lee, Kyu Chang; Kim, Dong Ik

Abstract

OBJECTIVES: This study was to define the clinical characteristics and formulate the management strategies of the patients with infectious cerebral aneurysms.
METHODS
During the past 30 years, among 2,830 patients who were treated with intracranial aneurysms, 11 patients had infectious cerebral aneurysms. The authors reviewed the database and the imaging studies as sources for identification and analysis.
RESULTS
Nine patients had ruptured lesions: Five patients presented with subarachnoid hemorrhage (SAH) and 4 patients presented with intracerebral hemorrhage (ICH). Two patients were Hunt and Hess Grade I, 1 Grade II, 2 Grade III, 3 Grade IV, and 1 Grade V. Seven aneurysms were located at middle cerebral artery, 2 at anterior cerebral artery, 1 at internal carotid artery, and 1 at posterior circulation. Ten aneurysms were small ((8 mm). Seven aneurysms were fusiform, and the remaining 4 aneurysms were saccular. Five of the 11 patients (44.4%) had multiple aneurysms. All patient were treated by microsurgery. The obliteration methods of the aneurysms were trapping in 7 patients, and neck clipping in 4 patients. Nine patients showed favorable outcome (good : 7, fair : 2) and 2 patients showed unfavorable outcome (poor : 1, dead : 1).
CONCLUSION
Infectious cerebral aneurysms had high frequency of ICH, fusiform-shape, multiple aneurysms, and initial poor clinical grade. Surgery was necessary for ruptured lesion and unruptured lesions which size was increased at follow up angiography. The ultimate management outcome was satisfactory. Co-work with cardiologist and cardiovascular surgeon is necessary.