Abstract
This is a case report of microsurgical removal of a ruptured intracranial infectious aneurysm with surrounding brain tissue based on the indocyanine green (ICG) videoangiography and histopathological evidence of adhesion between the aneurysm and brain. A 43-year-old man presented with sudden loss of consciousness and left hemiparesis. Computed tomography (CT) findings revealed an intraparenchymal hematoma in the right fronto-parietal lobe. Three dimensional CT angiography and digital subtraction angiography demonstrated a fusiform aneurysm of the distal middle cerebral artery (MCA) at the surface of the hematoma. Echocardiography revealed vegetation at the mitral valve, and he was diagnosed with infective endocarditis. The patient underwent superficial temporal artery (STA)-MCA anastomosis, excision of the aneurysm with surrounding brain tissue, and evacuation of the hematoma. Although the aneurysm could not be detected on the surface of the brain through microscopy, ICG videoangiography clearly revealed the aneurysm and the recipient artery, hidden by a thick subarachnoid hemorrhage and strong adhesions. ICG videoangiography was an effective procedure in this case. Histopathological findings demonstrated destruction of the aneurysmal wall structure and strong adhesions between the aneurysm and the brain tissue. These were consistent with the intraoperative findings.
