ArticleJournal of neurosurgery. Case lessons2026
A coexisting pseudoaneurysm hidden behind a saccular distal middle cerebral artery aneurysm in long-standing postirradiation vasculopathy: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDelayed cerebrovascular complications after childhood cranial irradiation may include progressive vasculopathy and aneurysmal disease. However, attributing a ruptured aneurysm directly to prior irradiation can be difficult in patients with complex preexisting cerebrovascular pathology. The authors describe a diagnostic pitfall in a patient with long-standing postirradiation vasculopathy who presented with hemorrhagic distal middle cerebral artery (MCA) aneurysmal lesions. OBSERVATIONS: A 51-year-old man who had undergone whole-brain irradiation for pineal germinoma at 8 years of age presented with intracerebral and subarachnoid hemorrhage. He had a long history of progressive cerebrovascular disease, including recurrent ischemic strokes, prior intracerebral hemorrhage, intracranial arterial stenosis, and a previously treated internal carotid artery aneurysm. MR angiography and initial digital subtraction angiography demonstrated a newly detected saccular distal MCA aneurysm, which was treated with coil embolization. Hematoma enlargement occurred the following day. Repeat angiography showed complete obliteration of the treated saccular aneurysm but revealed a coexisting pseudoaneurysm in the same vascular territory. Parent artery occlusion achieved definitive hemostasis without additional clinically apparent neurological deterioration. LESSONS: In patients with long-standing postirradiation vasculopathy, a conspicuous saccular aneurysm may obscure a coexisting pseudoaneurysm. Repeat angiography should be considered when hemorrhage progresses despite apparent aneurysm obliteration. https://thejns.org/doi/10.3171/CASE26561.
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