Endovascular Treatment of Cerebral Mycotic Aneurysm: A Review of the Literature and Single Center Experience

Figure 2

A patient with a history of intravenous drug abuse was admitted to an outside hospital for treatment of endocarditis. MRI at this time demonstrated multiple cerebral septic emboli and mycotic aneurysms (a–c). Two weeks after initiation of antibiotics, the patient had a significant headache and CT scan demonstrated new hemorrhage in the superior parietal lobe (d). The patient was transferred to our hospital for further care, and CTA and MRI at this time demonstrated 2 persistent mycotic aneurysms with hemorrhage surrounding the 7 mm aneurysm arising from the distal cortical branch from the middle cerebral artery (e–h). As the patient required a cardiac valve replacement and would receive full anticoagulation and had a hemorrhage 2 weeks after initiation of antibiotics, the intervention with the ruptured aneurysm was considered the best course of therapy. Due to the distal nature of the aneurysm, microsurgical removal was deemed the best therapy ((i), intraoperative image of cortically based aneurysm). Intraoperative angiogram demonstrated complete resection of the cortically based aneurysm with only the single aneurysm remaining (j, k). Follow CTA demonstrated resolution of the final remaining aneurysm.