J Korean Neurosurg Soc.  2014 Apr;55(4):222-225. 10.3340/jkns.2014.55.4.222.

Traumatic Aneurysm of the Callosomarginal Artery-Cortical Artery Junction from Penetrating Injury by Scissors

• Kim MS
• Sim SY

• KMID: 2191098
• DOI: http://doi.org/10.3340/jkns.2014.55.4.222

Abstract

Traumatic intracranial aneurysms (TICAs) are rare and are associated with high rates of morbidity and mortality. TICAs usually result from head injuries caused by traffic accidents, industrial accidents, or gunshots. We report a traumatic aneurysm of the callosomarginal artery-cortical artery junction arising from a penetrating injury by scissors. A 51-year-old woman was admitted to our hospital after suffering a penetrating injury caused by scissors. Computed tomography (CT) and CT-angiography demonstrated a right orbital roof fracture, subarachnoid hemorrhage, frontal lobe hemorrhage, intraventricular hemorrhage, and a traumatic aneurysm of the right callosomarginal artery-cortical artery junction. We trapped the traumatic aneurysm and repositioned a galeal flap. Postoperative CT showed a small infarction in the left frontal lobe. Follow-up angiography two months later showed no residual aneurysm. We suggest that an aggressive surgical intervention be performed whenever TICA is diagnosed.

Keyword

Pseudoaneurysm; Traumatic aneurysm; Distal anterior cerebral artery; Trapping

MeSH Terms

Accidents, Occupational
Accidents, Traffic
Aneurysm*
Aneurysm, False
Angiography
Arteries*
Craniocerebral Trauma
Female
Follow-Up Studies
Frontal Lobe
Hemorrhage
Humans
Infarction
Intracranial Aneurysm
Middle Aged
Mortality
Orbit
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Scissors after their removal by another person at the accident site.

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  Fig. 2 Patient's face at the time of admission reveals a laceration of the right upper eyelid.

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  Fig. 3 Computed tomography in the emergency department shows subarachnoid hemorrhage, frontal lobe hemorrhage, and intraventricular hemorrhage.

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  Fig. 4 Computed tomography-angiography shows fracture of the right orbital roof and a traumatic aneurysm of the callosomarginal artery-cortical artery junction [1 : right orbital fracture, 2 : right callosomarginal artery, 3 : right pericallosal artery (A4), 4 : traumatic anerusym, 5 : right long callosal artery, 6 : right pericallosal artey (A2), 7 : left pericallosal artery (A2), 8 : cortical artery].

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  Fig. 5 Intraoperative findings. This figure shows the trapping of the pseudoaneurysm of callosomarginal artery-cortical artery junction (arrow : cortical artery, red dotted line : callosomarginal artery, curved arrow : cystic dialation of cortical artery, red arrow : ruptured site, black dotted line : blade of proximal clip).

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  Fig. 6 Postoperative computed tomography reveals a small infarction in the left frontal lobe.

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  Fig. 7 Internal carotid angiography two months later demonstrates no flow in one cortical artery, but preserved flow in and stenosis of the right callosomarginal artery [1 : right pericallosal artery (A4), 2 : right callosomarginal artery, 3 : right long callosal artery, 4 : right pericallosal artery (A2), 5 : left pericallosal artery (A2)].

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