P.096 Iatrogenic pseudoaneurysm of the MCA secondary to VP shunt insertion

Abstract

Background: Ventriculoperitoneal (VP) shunting is a common treatment for hydrocephalus. Complications of VP shunt include infection, malfunction, and hemorrhage. Vascular complications such as pseudoaneurysm are rare, and usually involve the choroid plexus or branches of the external carotid artery. We present the case of a fusiform pseudoaneurysm of the middle cerebral artery arising due to VP shunt insertion. Methods: A 36-year-old female presented with a hypertensive cerebellar hemorrhage and hydrocephalus. This was treated with VP shunt placement with limited dural opening. Three weeks afterward there developed a diffuse intraventricular hemorrhage associated with hemorrhage at the cortical insertion site of the ventricular catheter. CT and catheter angiography revealed a fusiform pseudoaneurysm of the M4 segment of the MCA immediately adjacent to the ventricular catheter. Results: The VP shunt was removed, and the aneurysmal segment was coagulated and occluded. Delayed repeat VP shunt insertion was performed through the same entry point and trajectory via a larger dural opening. Conclusions: Pseudoaneurysm formation secondary to catheter insertion is a rare complication. To our knowledge, this is the second reported case of a cortical branch pseudoaneurysm in an adult. Careful consideration should be given to vascular anatomy when planning shunt insertions, and cruciate dural opening for local cortex visualization may help avoid this complication.