Middle Cerebral Artery Bifurcation Aneurysm: Ruptured Lobulated and Wide-Necked Aneurysm with Good Clinical Outcome after Treatment with a WEB-SL

Abstract

A 38-year-old female patient presented with a SAH Hunt and Hess III. CTA and DSA revealed a small, wide-necked, and multilobulated aneurysm of the left middle cerebral artery bifurcation. The aneurysm was treated by an endovascular approach. A single-layer WEB device 6/3 mm (MicroVention) was implanted without any complication. An initial Fisher grade IV SAH (mRS 5) with a hemorrhage in the left insular subarachnoid space resulted in an insular infarction, demonstrated from having a CT during the in-patient stay. An initial nonocclusive hydrocephalus was observed with an external ventricular drain, which could be removed 13 days after the SAH without neurological deterioration. The patient was moved to general neurosurgical ward and discharged in a good condition without a neurological deficit (mRS 0). Follow-up DSA six and 12 months after implantation of the WEB device showed a complete occlusion of the aneurysm. During follow-up, the patient did not reveal any new neurological deficit (mRS 0). The case confirms the possibility of WEB device implantation in acutely ruptured aneurysms, as well, and the safety of the procedure.