Infectious aneurysm clipping by an MRI/MRA wand-guided protocol - A case report and technical note

Infectious aneurysms are potentially deadly sequelae of multiple etiologies , typically associated with subacute bacterial endocarditis (SBE). Since th ese aneurysms tend to be distal, there are no consistent landmarks by which to localize them, in contrast to more typical aneurysms that occur on the circle of Willis or proximal, large cerebral vessel bifurcations. In additi on, they tend to be extremely friable and may be obscured by blood if intra cranial hemorrhage (ICH) has already occurred. These factors make clipping these aneurysms technically difficult, and searching for easily ruptured an eurysms without standard landmarks adds risk to the procedure. In this repo rt, we describe the case of a 9-year-old boy with SBE and subsequent ICH se condary to a mycotic aneurysm. This aneurysm was localized to within millim eters by the MRI protocol described herein. The aneurysm was excised and th e patient recovered without incident. Thus, MRI/MRA-guided frameless stereo taxy may be useful for localizing distal mycotic aneurysms, improving patie nt outcome by decreasing morbidity and mortality. Copyright (C) 2001 S. Kar ger AG, Basel.