Pseudoaneurysm of Distal Anterior Cerebral Artery Branch Following External Ventricular Drain Placement

BACKGROUND: External ventricular drains (EVDs) are routinely placed as part of the management of intracranial hypertension. Pseudoaneurysm formation after EVD placement is a rare complication that can occur as a result of direct trauma to the cerebral vasculature. Prompt recognition and treatment may prevent future rupture. OBJECTIVE: To present our management strategy of a unique case of pseudoaneurysm formation in the context of the medical literature on these rare complications. METHODS: An EVD was placed in a 58-year-old female patient who presented with intracranial hypertension after subarachnoid hemorrhage secondary to a ruptured posterior communicating artery aneurysm before coiling of the aneurysm. On postbleed day 10, a pseudoaneurysm was identified in the distal anterior cerebral artery adjacent to the EVD tract. RESULTS: The pseudoaneurysm was successfully treated with surgical resection. CONCLUSION: Pseudoaneurysm formation after EVD placement is a rare but serious complication. We do not recommend routine screening for this complication; however, further investigation may be warranted when a delayed EVD tract hemorrhage is encountered. Prompt treatment of pseudoaneurysms is necessary to prevent future hemorrhage. ABBREVIATIONS: ACA, anterior cerebral artery EVD, external ventricular drain