Objective:

Background:

Pericallosal artery aneurysms (PAAs) are rare, comprising 1-9% of intracranial aneurysms, with a higher odds ratio of rupture, ranging from 2.5-4.7. There remains a low threshold to treat even when discovered incidentally with either microsurgical or endovascular techniques. Often, PAAs are ideal for microsurgical clipping because of their distal location and need for preservation of parent vasculature associated with the neck or dome, however, based on patient characteristics, endovascular treatment may be favorable.

Design/Methods:

62-year-old male with a history of hypertension presented unresponsive, Hunt-Hess 5, complaining of headaches days prior. CT Brain revealed a small left frontal, convexity subarachnoid hemorrhage (SAH) and CTA demonstrated a 5mm PAA and a 3mm aneurysm on the ICA terminus. Emergent external ventricular drain was placed with improvement in neurological examination. MRI Brain demonstrated a left parieto-occipital cortical infarct. Additionally, the patient was found to be bacteremic with positive UA and pneumonia and in acute renal failure. Diagnostic cerebral angiogram confirmed an irregular PAA filling from the left, measuring 4.5x3mm and a frontopolar branch exiting from the neck of the aneurysm. Given the location of SAH and the radiographic appearance, treatment of the PAA was deemed indicated. Based on multiple medical comorbidities and high-grade status, endovascular coiling secured and obliterated the aneurysm while taking care to preserve the involved frontopolar branch. 

Results:

Post-operative Day 11 repeat angiogram revealed a secured aneurysm with minimal residual flow at the neck and patency of the involved frontopolar branch. The patient was discharged to rehab with a modified Rankin Scale of 4.

Conclusions: