Fungal symptomatic intracranial aneurysm treated with a flow diverting stent: A case report

Abstract

Background: Intracranial infectious aneurysms (IIAs) are very rare, and fungal aneurysms are infrequently reported. We report a case of an unruptured IIA caused by fungal rhinosinusitis and treated with a flow-diverting stent.

Case description: An 81-year-old woman visited the ophthalmology department with impaired eye movement and ptosis and was placed under follow-up. A week later, she also developed a headache; magnetic resonance angiography revealed an aneurysm measuring 2 mm in the C4 portion of the right internal carotid artery. A 3-week follow-up with contrast-enhanced magnetic resonance imaging showed an increase in its size to 10 mm, and a contrast lesion was observed surrounding the right cavernous sinus. The patient started treatment with voriconazole and steroids on the same day. Ten weeks later, despite improvements in inflammation, the size of the aneurysm was unchanged; we, therefore, treated the aneurysm with a flow-diverting stent. Oculomotor nerve palsy improved, and the patient was discharged to a rehabilitation hospital 28 days after the placement, with a modified Rankin Scale of 4. A 1-year follow-up angiogram showed a partial decrease in the size of the aneurysm, with an O'Kelly-Marotta grading scale of B3.

Conclusion: IIAs grow rapidly, and the risk of rupture is high due to the weakening of the aneurysmal wall. To reduce the risks of rupture and recurrence after treatment, the infection should be treated before inserting a flow-diverting stent. Flow-diverting stent placement may be an effective treatment for IIA once the original infection has been cured.

Keywords: Flow diverting stent; Intracranial fungal aneurysm; Intracranial infectious aneurysm.

Figure 1:

(a and b) First magnetic resonance angiography of the aneurysm, with a size of approximately 2 mm (arrow and arrowhead). (c and d) The aneurysm size increased to 10 mm in 2 weeks (arrow and arrowhead). (e and f) Contrast-enhanced magnetic resonance imaging demonstrates a contrast-enhanced lesion from the right cavernous sinus to the orbital apex, which communicates with the sphenoid sinus.

Figure 2:

(a and b) First angiogram demonstrating the aneurysm in the cavernous portion of the right internal carotid artery with wall irregularities. (c and d) Angiogram after six weeks of medical treatment exhibiting the aneurysm dilatation and shape change. (e and f) Arterial phase and venous phase of angiogram one year after flow diverting stent placement. O’Kelly-Marotta grading scale: B3.