Ruptured bilateral pericallosal artery aneurysm in mirror position: case report and review of the literature

Case Presentation: A 46-years old woman was referred to our institution 20 days after sudden severe headache. She informed to treat arterial hypertension and smoke about 20 cigarette/day. The patient was neurologically intact at admission. Non-contrast computed tomography (CT) on the first day of symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). AngioTC/digital subtraction arteriography showed resolution of hydrocephaly and bilateral pericallosal artery (PA) aneurysms in mirror position. The patient was successfully treated by surgery without any complication. The patient was discharged home on the fourth post-operative day not having any additional neurological deficits.

Discussion: Pericallosal artery (PA) aneurysms represent 2% to 9% of all intracranial aneurysms and their management remains difficult. They can be divided as spontaneous or traumatic aneurysm according to the mechanism related to the origin of this disease. The diagnosis and treatment of pericallosal aneurysm should be done as early as possible, preventing rebleeding and the comorbidities associated with it. Direct surgical clipping or endovascular embolization compose the viable treatment options. Considering surgical clipping, several are the difficulties: a narrow space of surgical field (interhemisferic fissure and callosal cisterns are very narrow, specially in the presence of hydrocefalus), the aneurysm may be fixed to the pia- ater of cingulate gyrus, the majority of aneurysm are small in size and the presence of bridging veins in the surgical operative field make for a hard-surgical approach.

Final Comments: Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, operative management of ruptured bilateral PA aneurysms is feasible and effective.