Korean J Neurotrauma.  2015 Oct;11(2):124-130. 10.13004/kjnt.2015.11.2.124.

Clinical Analysis of Traumatic Cerebral Pseudoaneurysms

• Moon TH
• Kim SH
• Lee JW
• Huh SK

• KMID: 2378270
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.124

Abstract

OBJECTIVE
Traumatic pseudoaneurysms are rare but life-threatening lesions. We investigated the patients with these lesions to clarify their clinical characteristics and therapeutic strategies and we also reviewed the literatures on the treatment principles, possible options, and outcomes.
METHODS
There were a total of 8 patients who were treated with traumatic intracranial pseudoaneurysms between April 1980 and January 2009. Medical charts and the imaging studies were reviewed for analysis. The outcome was measured with modified Rankin Scale (mRS) score at 6 months after treatment.
RESULTS
All 8 patients were male and the mean age was 25 years old. Six of those were located at the cavernous segment of the internal carotid artery (ICA) and the other 2 was located at the M2 segment of middle cerebral artery. The causes of trauma were car accidents in 6, penetrating injury through the orbit in 1, and slip down injury in 1 patient. Massive epistaxis or hematemesis occurred in all patients with a pseudoaneurysm at the cavernous and ophthalmic segment of the ICA. All 6 patients of the cavernous and ophthalmic ICA group showed favorable outcome of mRS 0 to 1. The outcome of patients with middle cerebral artery pseudoaneurysm was mRS 2 to 3.
CONCLUSION
Upon prompt diagnosis and proper treatment planning, it is possible to achieve favorable outcome in these patients. Lesions located at the cavernous segment of the ICA favored endovascular treatment while those at the middle cerebral artery favored surgical treatment.

Keyword

Subarachnoid hemorrhage; Aneurysm, false; Intracranial aneurysm; Craniocerebral trauma

MeSH Terms

Aneurysm, False*
Carotid Artery, Internal
Craniocerebral Trauma
Diagnosis
Epistaxis
Hematemesis
Humans
Intracranial Aneurysm
Male
Middle Cerebral Artery
Orbit
Subarachnoid Hemorrhage

Figure

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  FIGURE 1 Lateral internal carotid artery (ICA) angiogram showing filling of a pseudosac at the cavernous segment of the ICA.

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  FIGURE 2 Magnetic resonance imaging showing a large pseudoaneurysm of cavernous segment of the internal carotid artery (A) and postoperative image showing decrease in aneurysm size (B).

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  FIGURE 3 Lateral angiogram of the internal carotid artery (ICA) showing a pseudoaneurysm of the cavernous segment of the ICA (A). Coil embolization (B) and balloon occlusion (C) of the parent artery.

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  FIGURE 4 A: Non-contrast computed tomography (CT) showing subarachnoid hemorrhage. B: CT angiogram showing a pseudosac at the middle cerebral artery. C: Postoperative angiography showing no residual filling of the pseudosac.

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  FIGURE 5 Gradient echo magnetic resonance imaging showing contusion injury of the brain and three-dimensional reconstructed view of a pseudoaneurysm of the middle cerebral artery.

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  FIGURE 6 Initial and follow-up angiography of a middle cerebral artery pseudoaneurysm showing increase in size.

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