Heart-shaped intracranial aneurysm

Aneurisma intracraniano em forma de coração

A 45-year-old woman presented with severe headache for three hours. Non-contrast brain CT revealed subarachnoid hemorrhage, mostly in the prepontine cistern ( Figure A). A catheter-based angiogram showed a heart-shaped aneurysm arising from the junction of the basilar artery and the left superior cerebellar artery ( Figures B and C), which was then coiled uneventfully ( Figure D).

Figure
(A) Non-contrast head CT shows subarachnoid hemorrhage in the prepontine cistern. (B-C) Catheter-based angiogram shows a heart-shaped saccular aneurysm (arrows) originating from the bifurcation of the basilar artery and the left superior cerebellar artery. (D) Postoperative angiogram shows the aneurysm (arrow) coiled successfully.

Cerebral aneurysm with a heart-shaped configuration is interesting and extremely rare, which is usually associated with vessel-wall degeneration under hemodynamic stress ¹ . Surgical clipping is challenging because of the complex anatomic environment and fragile aneurysmal wall; while an endovascular procedure, as a straightforward option, seems to be feasible and effective ^2,3 .

References

• ¹
  Vajkoczy P, Hartmann M. An unusual saccular aneurysm. N Engl J Med. 2002 Feb;346(7):497. https://doi.org/10.1056/NEJMicm010008
  » https://doi.org/10.1056/NEJMicm010008
• ²
  Fu C, Zhao C, Zhao H, Li D, Yu W. Growing dissecting aneurysm of basilar trunk treated with stent-assisted coiling. J Stroke Cerebrovasc Dis. 2015 Jan;24(1):e5-9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.07.033
  » https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.07.033
• ³
  Gong D, Yan B, Dowling R, Mitchell P. Successful treatment of growing basilar artery dissecting aneurysm by Pipeline flow diversion embolization device. J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1713-6. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.019
  » https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.019

Publication Dates

• Publication in this collection
  Jan 2019

History

• Received
  28 Aug 2018
• Accepted
  01 Oct 2018