Surgical treatment of lenticulostriate aneurysms (a case report and literature review)

Abstract

The study objective is to describe a rare case of putaminal intracerebral hemorrhage (PICH) results from a rupture of the distal lateral lenticulostriate artery (LSA) aneurysm and to summarize currently available information on its diagnosis and treatment.Materials and methods. A 40-year-old female patient was admitted to the N.V. Sklifosovsky Research Institute of Emergency Medicine. Her arterial pressure was 200/110 mm Hg. Brain computed tomography (CT) revealed a 25 сm3 right-sided PICH with a minimal perifocal edema. CT angiography revealed a saccular aneurysm located in the right distal LSA with the dome of 5 mm and the neck of 2 mm. We performed right frontotemporoparietal osteoplastic craniotomy and used the transsylvian transinsular approach to PICH represented by ruptured while we were removing the blood clots. We performed aneurysm trapping and removed the hematoma.Results. This clinical case demonstrates the possibility of successful microsurgical repair of the distal lateral LSA aneurysm rupture. Six months postoperatively, the patient had complete regression of left leg paresis and partial restoration of left hand functions.Conclusion. This case report appears quite interesting since deep intracerebral hematomas of this etiology are extremely rare. An optimal treatment for LSA aneurysms remains a subject of debate due to the small number of patients with this disorder and limited data on it. Patients with fusiform aneurysms require conservative treatment and dynamic follow-up with periodic cerebral angiography. Patients with typical saccular aneurysms or PICH presenting mass effect should undergo surgical treatment.