Cushing's Reflex Associated with Ruptured Cerebral Aneurysm during Intracranial Meningioma Surgery : A case report

ABSTRACT

The intracranial meningioma associated with hidden cerebral aneurysm is rare. We experienced a patient with subarachnoid hemorrhage (SAH) due to the rupture of cerebral aneurysm during intracranial meningioma removal, although preoperative 6-vessel angiographic study did not reveal aneurysmal dilatation. During operation, tumor was resected piece by piece, and totally removed, grossly. After removal of tumor, the brain swollen suddenly along with hypertension and bradycardia suspecting Cushing's reflex was developed. Emergent postoperative CT and CT-angiographic study revealed large amount of SAH and ruptured aneurysmal dilation of A3 segment of anterior cerebral artery. She died from brainstem failure on 4th postoperative day. We report a rare case of anesthesia for coexisting intracranial meningioma and intracranial aneurysm.