Management strategy for infectious cerebral aneurysms: Report of four cases

The surgical and/or endovascular treatment of four patients with infectious cerebral aneurysm associated with infective endocarditis was reported. Two patients presented with intracerebral hemorrhage. One of them, with large hematoma, was treated surgically and the other, with small hematoma, was treated by endovascular surgery. The third patient, with unruptured aneurysm of the distal anterior cerebral artery, was treated by endovascular parent-artery occlusion without neurological deterioration. The fourth patient, with unruptured aneurysm of the distal middle cerebral artery, was initially treated with antibiotics, resulting in stabilization of the aneurysm. However, three weeks after open heart surgery, the aneurysm ruptured, causing a large cerebral hematoma. Despite prompt evacuation of the hematoma and surgical resection of the aneurysm, this patient remained in a vegetative state. Management strategy of intracranial infective aneurysms is discussed.