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Year : 2015  |  Volume : 10  |  Issue : 4  |  Page : 327-330

The unusual angiographic course of intracranial pseudoaneurysms

1 Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, USA
2 Department of Neurosurgery, University of Virginia, School of Medicine, Charlottesville, Virginia, USA
3 Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA

Correspondence Address:
David Hasan
Department of Neurological Surgery, Division of Endovascular and Neurovascular Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, JCP 1616, Iowa City, IA 52242
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1793-5482.162721

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Although rare, traumatic intracranial pseudoaneurysms remain one of the most difficult vascular lesions to diagnose and treat. A 55-year-old male patient underwent endoscopic endonasal transphenoidal resection for a pituitary macroadenoma. The operation was complicated by an arterial bleed. The initial angiogram revealed pseudoaneurysm of the anterior choroidal artery. Although the pseudoaneurysm completely disappeared on the second angiogram, it was surprisingly found to have enlarged on the third angiogram. The lesion was successfully treated with flow-diversion using a pipeline embolization device. The present case demonstrates that the natural history of iatrogenic pseudoaneurysms may be unpredictable and misleading. Traumatic pseudoaneurysms should, therefore, be carefully followed when conservative treatment is elected or when the lesion seems to have spontaneously regressed. Flow-diversion seems to be a reasonable treatment option.

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