Case of Subarachnoid Hemorrhage from Ruptured Oncotic Fusiform Aneurysms from Choriocarcinoma Metastasis Treated with Aneurysmectomy and Vessel Reconstruction.

Abstract

Oncotic aneurysm is a rare condition with a high mortality rate. Because no consensus has been reached regarding therapeutic strategy for ruptured oncotic aneurysm, treatment remains challenging. A 35-year-old woman developed sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage and cerebral angiography revealed 2 fusiform aneurysms in the distal portion of the left middle cerebral artery. Aneurysmectomy with vessel reconstruction using a superficial temporal artery graft was performed to maintain blood flow to the distal middle cerebral artery. Pathologic examination of the aneurysm and wall of the resected recipient middle cerebral artery showed infiltrating trophoblasts. Immunostaining for human chorionic gonadotropin was positive in the aneurysm specimen. On the basis of an elevated concentration of serum human chorionic gonadotropin, choriocarcinoma with ruptured intracranial oncotic aneurysms was diagnosed. After further systemic examination for carcinoma, chemotherapy was initiated. Aneurysmectomy, resection of the parent artery with irregular walls and reconstruction to the distal recipient artery with normal intima should be considered to secure patency of the anastomosis and prevent the recurrence of oncotic aneurysm. Subsequent chemotherapy is essential to prevent carcinomatous meningitis and disease progression.