Pseudoaneurysm of Distal Anterior Cerebral Artery Secondary to External Ventricular Drain: A Case Report and Review of the Literature

Abstract

BACKGROUND AND IMPORTANCE: External ventricular drain (EVD) placement is a common neurosurgical procedure. The risk of hemorrhage is well documented, and the associated risk of pseudoaneurysm is quite rare. Our objective is to report our case of EVD-associated pseudoaneurysm, review the published literature, and suggest management. CLINICAL PRESENTATION: A 66-year-old woman presented with subarachnoid hemorrhage secondary to a ruptured posterior communicating artery aneurysm, hydrocephalus was managed with bilateral EVD placement, and the ruptured aneurysm treated with coil embolization. The EVDs were removed, and a tract hemorrhage was noted on the right. Routine imaging 3 months later revealed a cortical pseudoaneurysm along the previous right-sided EVD tract. The pseudoaneurysm was successfully treated with clipping, and the patient is neurologically intact. CONCLUSION: This is the first case to report pseudoaneurysm diagnosis after tract hemorrhage upon EVD removal. Prompt treatment is imperative. We recommend considering vascular imaging in any case with hemorrhage upon EVD removal.