Cerebral microaneurysms, which are 2 mm or small in size, are a rare cause of subarachnoid hemorrhage (SAH). The authors present 2 cases with ruptured microaneurysms, in which 3-dimensional (3D) fast spin-echo T1 imaging with variable flip angles (CUBE T1) using gadolinium-diethylenetriaminepentaacetic acid (Gd) enhancement was useful in diagnosing the microaneurysms as the source of bleeding. Case 1 was a 61-year-old woman who had an SAH localized to the left Sylvian fissure. A small bulge (1.4 mm) at the bifurcation of left middle cerebral artery (MCA), which was detected by 3D angiography, was well enhanced by CUBE T1 with Gd enhancement. The patient was successfully treated by trapping of the lower division of the left M2 segment with superficial temporal artery–M3 bypass. The intraoperative findings indicated that the microaneurysm at the bifurcation of the left MCA was the ruptured site. Case 2 was a 41-year-old man who had a diffuse SAH. A small bulge (1.5 mm) at the inferolateral wall of the left internal carotid artery (ICA), which was detected by 3D angiography, was well enhanced by CUBE T1 with Gd enhancement. The patient was treated by trapping of the left ICA with external carotid artery–saphenous vein graft–M2 bypass without complications. The intraoperative findings indicated that the microaneurysm at the inferolateral wall of the left ICA was the ruptured site. CUBE T1 with Gd enhancement was useful as an adjunctive tool for the diagnosis of ruptured cerebral microaneurysms. This sequence might enable neurosurgeons to perform curative surgery with certainty for ruptured microaneurysms.
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- The fate of intracranial microaneurysms treated with bipolar electrocoagulation and parent vessel reinforcement.Neurosurgery. 1999; 45 (discussion 4-5): 1172-1174
- Angiographically unrecognized microaneurysms: intraoperative observation and operative technique.Acta Neurochir (Wien). 1997; 139 (discussion 9-20): 416-419
- Additional value of 3D rotational angiography in angiographically negative aneurysmal subarachnoid hemorrhage: how negative is negative?.AJNR Am J Neuroradiol. 2008; 29: 962-966
- 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms.AJNR Am J Neuroradiol. 2008; 29: 976-979
- Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle.Neurosurgery. 2013; 72 (discussion 6): 492-496
- Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm?.Clin Neuroradiol. 2014; ([Epub ahead of print])
- Pathological consideration of a “blister-like” aneurysm at the superior wall of the internal carotid artery: case report.Neurosurgery. 1997; 40 (discussion 5-6): 403-405
- Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome.J Neurosurg. 2008; 108: 662-671
Published online: May 23, 2015
Accepted: April 23, 2015
Received in revised form: April 9, 2015
Received: December 12, 2014
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.