"Occult" Ruptured Infectious Aneurysm of the Distal Anterior Cerebral Artery: Case Report / 대한뇌혈관외과학회지

A 58-year-old man who underwent mitral valve replacement for mitral valve prolapse that was complicated by severe mitral regurgitation was referred to our department due to his sudden onset of drowsiness. Brain computed tomography revealed a hemorrhage in the anterior interhemispheric fissure and left frontal lobe. Cerebral angiography demonstrated a saccular aneurysm at the angular branch of the middle cerebral artery (MCA), but there was no evidence of vascular abnormalities at the hemorrhagic area. End-to-end anastomosis of the angular branch was performed after resection of the friable aneurysm and the perianeurysmal parent artery segment. Follow-up cerebral angiography after three weeks showed an aneurysm in the distal anterior cerebral artery (ACA) in the previously hemorrhagic area. This ruptured aneurysm was successfully clipped. An infectious aneurysm was confirmed on the histopathological examination.

In Situ Floating Resin Cranioplasty for Cerebral Decompression

The purpose of this report is to describe our surgical experiences in the treatment of cerebral decompression with in situ floating resin cranioplasty. We included in this retrospective study 7 patients who underwent in situ floating resin cranioplasty for cerebral decompression between December 2006 and March 2008. Of these patients, 3 patients had traumatic brain injury, 3 cerebral infarction, and one subarachnoid hemorrhage due to aneurysmal rupture. In situ floating resin cranioplasty for cerebral decompression can reduce complications related to the absence of a bone flap and allow reconstruction by secondary cranioplasty without difficulty. Furthermore, it provides cerebral protection and selectively eliminates the need for secondary cranioplasty in elderly patients or patients who have experienced unfavorable outcome.