Iatrogenic cortical pseudoaneurysm following ventriculoperitoneal shunt insertion presenting with intraventricular hemorrhage

Abstract

Background: Cerebral pseudoaneurysm formation associated with ventricular catheterization is an exceedingly rare complication that results from direct catheter-induced injury to a vessel. We report a case of intracerebral pseudoaneurysm formation associated with ventricular catheterization in a patient with hydrocephalus following aneurysmal subarachnoid hemorrhage. Case Description: The patient presented with aneurysmal subarachnoid hemorrhage and underwent partial endovascular embolization of the offending wide-necked basilar tip aneurysm with the plan for a Stage 2 stent-assisted coiling after initial recovery. Before discharge, a ventriculoperitoneal shunt (VPS) was placed for postaneurysmal hydrocephalus. Three weeks later, she presented with intraparenchymal and intraventricular hemorrhage. Angiography revealed a cortical aneurysm contiguous to the ventricular catheter of the VPS. She underwent microsurgical excision of the aneurysm, and a new VPS was placed after resolution of the intraventricular hemorrhage. She later underwent the second stage of the treatment and had an excellent neurological recovery to an independent state. Conclusion: Iatrogenic intracerebral pseudoaneurysm formation is an exceedingly rare complication of ventricular catheterization but is associated with significant mortality. Identifying a pseudoaneurysm in this context warrants prompt and definitive treatment with microsurgical or endovascular treatment.

Internal carotid artery false aneurysm as a fatal complication of transsphenoidal surgery

“…The common causes are trauma, infectious diseases, irradiation, iatrogenic injuries, collagen vascular diseases or rupture of true aneurysm [ 1 ]. Iatrogenic injuries can be a complication of different surgical procedures, including ventriculoperitoneal shunt insertion [ 2 ], endoscopic third ventriculostomy [ 3 ], endonasal sinus [ 4 ] or transsphenoidal surgery [ 5 ]. The reported incidence of false aneurysms after transsphenoidal surgery varies between 0.2 and 2% [ 6 ].…”