Abstract
We managed a patient with intracranial mycotic aneurysm (IMA) that was associated with infective endocarditis and treated with endovascular embolization under visual evoked potential (VEP) monitoring. Here, we report our experience with a review of the literature.
A 31-year-old man with mitral valve regurgitation presented to our hospital. His chief complaint was fever and there was no neurological deficit. Cerebral angiography revealed a fusiform-shaped aneurysm, approximately 3.5 mm in size, at the origin of the left calcarine artery. The aneurysm enlarged gradually despite administering antibiotic therapy. We performed endovascular treatment of the aneurysm under general anesthesia and VEP monitoring. During balloon test occlusion (BTO) of the P3 portion of the left posterior cerebral artery, VEP amplitude of the left side was slightly reduced. Therefore, we embolized the fusiform aneurysm at the origin of the left calcarine artery and deployed the stent to the left parieto-occipital artery to preserve its patency. The VEP amplitude was not attenuated. After coil embolization of the aneurysm, there were no neurological deficits, including visual field defects.
Coil embolization under VEP monitoring is useful for functional preservation when treating aneurysms of the posterior cerebral artery branches.
