[Successful treatment of a ruptured anterior cerebral artery dissecting aneurysm].

Abstract

Dissection with subarachnoid hemorrhage is an unstable and dangerous condition because of the high rate of rerupture. The mortality of dissecting pseudoaneurysm is the worst among cerebral aneurysms. Dissecting pseudoaneurysms causing subarachnoid hemorrhage should be treated by endovascular intervention in the acute phase in most of the cases. Life-saving intervention must be performed urgently. Based on the treatment principle, interventions can be divided into two groups: deconstructive techniques involving the occlusion of the parent vessel and reconstructive techniques involving the preservation of the parent vessel. During reconstructive endovascular treatment, we currently use flow diverters, the disadvantage of which is that they require double platelet aggregation treatment, which complicates or prevents further open neurosurgical operations. A deconstructive technique is occlusion of the parent vessel proximal to the origin of the dissection. Good radiological and clinical results can be achieved using both techniques. In our case report, the unconscious state of a young boy was caused by massive ventricular hemorrhage and cerebral hematoma, the background of which was the rupture of an A2 dissection pseudoaneurysm. Parent vessel occlusion was performed urgently, while preserving the Heubner artery. With our treatment, a symptom-free recovery was achieved.