Iatrogenic pseudoaneurysm rupture of the anterior cerebral artery after placement of an external ventricular drain, treated with clip-wrapping: a case report and review of the literature
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External ventricular drains (EVDs) are often placed emergently for patients with hydrocephalus, which carries a risk of hemorrhage. Rarely, rupture of a pseudoaneurysm originating from an EVD placement precipitates such a hemorrhage. An EVD was placed in a patient with a ruptured left posterior communicating artery aneurysm who later underwent endovascular coil embolization. On post-bleed day 20, a distal right anterior cerebral artery pseudoaneurysm along the EVD tract ruptured, which was successfully treated via clip-wrapping. Although EVD-associated pseudoaneurysms are rare, they have a high propensity for rupture. Early treatment of these lesions should be considered to prevent neurologic deterioration.
KeywordsClip-wrapping External ventricular drain Iatrogenic pseudoaneurysm rupture
Anterior cerebral artery
Computed tomography angiography
External ventricular drain
Glasgow Coma Scale
Posterior communicating artery
The authors thank the Neuroscience Publications staff at Barrow Neurological Institute for their help with the manuscript preparation.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The current case report was exempt from IRB review, and consent for the report was obtained by a medical power of attorney.
- 1.Anderson RC, Kan P, Klimo P, Brockmeyer DL, Walker ML, Kestle JR (2004) Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg 101:53–58Google Scholar
- 8.Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF (2008) Safety and accuracy of bedside external ventricular drain placement. Neurosurgery 63:ONS162–166; discussion ONS166-167Google Scholar
- 11.Kosty J, Pukenas B, Smith M, Storm PB, Zager E, Stiefel M, Leroux P, Hurst R (2013) Iatrogenic vascular complications associated with external ventricular drain placement: a report of 8 cases and review of the literature. Neurosurgery 72:ons208–ons213 discussion ons213Google Scholar
- 15.Maniker AH, Vaynman AY, Karimi RJ, Sabit AO, Holland B (2006) Hemorrhagic complications of external ventricular drainage. Neurosurgery 59:ONS419–ONS424 discussion ONS424-415Google Scholar
- 25.Ross IB, Dhillon GS (2003) Ventriculostomy-related cerebral hemorrhages after endovascular aneurysm treatment. AJNR Am J Neuroradiol 24:1528–1531Google Scholar
- 28.Scholz C, Hubbe U, Deininger M, Deininger MH (2013) Hemorrhage rates of external ventricular drain (EVD), intracranial pressure gauge (ICP) or combined EVD and ICP gauge placement within 48 h of endovascular coil embolization of cerebral aneurysms. Clin Neurol Neurosurg 115:1399–1402CrossRefGoogle Scholar