2025 Volume 53 Issue 3 Pages 177-181
Mycotic aneurysms often cause serious subarachnoid hemorrhages. Appropriate diagnosis and treatment are paramount. This case report described a one-year-old girl with an endocarditis-related mycotic aneurysm of the middle cerebral artery (MCA) that was treated with superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass and trapping surgery.
The infant experienced infective endocarditis after surgery for a ventricular septal defect. She was initially treated with antibiotics. However, cerebral infarction due to occlusion of the right M2 superior trunk of the MCA. Multiple mycotic aneurysms at posterior cerebral artery (PCA) were detected on computed tomographic angiography (CTA). After 1 week, the mycotic aneurysm of PCA disappeared, and the right M2 superior trunk recanalized to form a mycotic aneurysm. This lesion was at high risk of hemorrhage. We performed a direct surgery to prevent rupture of the mycotic aneurysm in the M2 superior trunk. During the surgical procedure, severe stenosis in the parent artery of the aneurysm was detected. Therefore, we performed an STA-MCA bypass just distal to the aneurysm. We could safely trap the aneurysm because of the bypass. The aneurysm was resolved without adverse events. The remaining aneurysms were managed by antibiotic therapy. Mycotic aneurysms have fragile walls, and neck clipping and coil embolization are often difficult. Hence, parent artery occlusion (PAO) is often considered. If the lesion is eloquent, bypass surgery should be performed because of the risk of widespread ischemia.
