Microsurgical clipping of an unusual progressive enlarging venous aneurysm associated with cerebral proliferative angiopathy.

Background: Cerebral venous aneurysms are usually caused by abnormalities in the venous drainage system or alterations in the venous pressure, occurring in arteriovenous fistulas, developmental venous anomalies, arteriovenous malformations, and proliferative angiopathy. A rupture may represent a tragic event, since it may be associated with subarachnoid or intraparenchymal hemorrhage, edema and hydrocephalus, and hence, worsening of the quality of life. Case Description: A previously healthy 31-year-old female presenting with a lowering of consciousness level, with investigation examinations revealing intraventricular hemorrhage and a left frontal proliferative angiopathy. The patient gradually recovered after hydrocephalus emergency treatment followed by rehabilitation; however, follow-up examinations revealed the emergence of a venous aneurysm at a draining vein of the proliferative angiopathy into the inferior sagittal sinus. The aneurysm eventually increased and changed its shape, and black-blood magnetic resonance imaging revealed contrast enhancement on its wall. All these factors, in the context of a young patient with previous cerebral hemorrhage led to the decision of microsurgical clipping of the venous aneurysm, preceded by embolization of a distal branch of the right middle meningeal artery, for the purpose of diminishing the venous pressure and facilitating the surgical manipulation of the venous system. No clinical or neurological complications were observed after surgical treatment, and postoperative examinations indicated the exclusion of the aneurysm and preservation of the venous flow. Conclusion: This case highlights how the microsurgical treatment of an unusual enlarging cerebral venous aneurysm, along with preoperative endovascular therapy, may be effective and prevent complications of rupture in a young patient.