Abstract
Traumatic intracranial aneurysms have been reported to have a poor prognosis due to delayed rupture. We report here two cases of ruptured traumatic anterior cerebral artery (ACA) aneurysms that were successfully treated by direct neck clipping. A 16-year-old girl and a 22-year-old man presented with subarachnoid hemorrhage 26 days and 76 days after blunt head injuries, respectively. In the former case, angiography demonstrated two distal ACA aneurysms; one was a right A2 aneurysm with a diameter of 10mm and the other was a left A2 aneurysm with a diameter of 2mm. On the 46th day after the head injury, the aneurysms were explored via an interhemispheric approach, following an A3-A3 side-to-side anastomosis performed in advance for prevention of ischemia during a relatively long temporary or permanent occlusion of the A2. The right A2 aneurysm was thrombosed and larger than shown on angiograms; neck clipping was successfully performed by intraaneurysmal thrombectomy under aneurysm trapping. The right A2 aneurysm was clipped without any difficulties. In the latter case, an A3 aneurysm with a diameter of 5mm was revealed by angiography. On the 97th day after the head injury, the aneurysm was explored via an interhemispheric approach. Like the former case, the aneurysm was thrombosed and larger than shown on angiograms. Neck clipping was performed while maintaining patency of the A3, following intraaneurysmal thrombectomy under aneurysm trapping. The pathological diagnoses were pseudoaneurysms consisting of thick connective tissues in both cases. The clinical course had no troubles with good activity of daily life. In conclusion, traumatic cerebral aneurysms may be thrombosed pseudoaneurysms. These aneurysms can be clipped following intraaneurysmal thrombectomy. However, cerebrovascular reconstruction should be considered to prevent ischemia in the area distal to the lesions.
