Combined Treatment of Ruptured Intracranial Infectious Aneurysm Accompanied by Intracerebral Hemorrhage: Endovascular Treatment and Neuroendoscopy

Intracranial infectious aneurysms (IIAs) are very rare. Most IIAs are associated with infective endocarditis (IE). The treatment of ruptured IIAs with intracerebral hemorrhage (ICH) remains challenging. Here, the authors aimed to describe a minimally invasive approach, combining endovascular treatment (EVT) with endoscopic techniques, for this complex issue. From January 2019 to December 2021, 3 cases of ruptured IIAs with intracerebral hemorrhage treated with EVT and neuroendoscopic hematoma evacuation at Guangdong Provincial People’s Hospital were included in this study. We retrospectively reviewed the clinical and imaging data and postoperative follow-up. All the IIAs were located in the middle cerebral arteries. The IIAs were secured by embolizing the aneurysms and occluding the parent artery. The ICH was evacuated using neuroendoscopy without postoperative rebleeding. After IIAs treatment, 2 patients underwent cardiac surgery, one at 10 days postoperatively and the other at 1 month postoperatively. At the 1-year follow-up, all patients resumed their normal lives. EVT and neuroendoscopic therapy for ruptured IIAs with ICH in patients is a useful complement to current treatment strategies.