Delayed postoperative hemorrhage from intracranial aneurysm after craniotomy for tumor

Abstract

Intracranial hemorrhage of apoplectiform type due to ruptured arterial aneurysm and of delayed onset after surgery for intracranial tumor is rarely reported, 1 case being found in the world literature of the last 65 years. This case, one of aneurysm secondary to surgical trauma, and 2 previously unreported instances of postoperative aneurysmal bleeding present several striking similarities, which, despite etiologic differences, might be taken as being characteristic of this problem. In all 3 cases, tumor removal was marked by difficulty with bleeding vessels in the region of the subsequently discovered ruptured aneurysm. In each case, the patient was improving postoperatively when massive bleeding took place on the 12th, 17th, and 28th days, respectively. A 4th patient, with aneurysm seen at surgery, died after suddenly going into coma on the 2nd day after operation, presumably with ruptured aneurysm. The coexistence of preexisting intracranial saccular aneurysm in cases of primary intracranial neoplasm is not as rare as the literature would indicate, since a total of 9 such previously unreported cases were found. Of these, 5 were seen in a series of 1500 neoplasms. The figure of 0.33% for the incidence of aneurysm in cases of brain tumor (derived from this data) is probably low. Since positive histopathologic criteria upon which to base a diagnosis of traumatic saccular aneurysm do not exist except in theory, a definite diagnosis of aneurysm secondary to surgery cannot be reasonably made without clear evidence that no such aneurysm existed until after operation. It is suggested that decompressive tumor surgery may accelerate some of the pathologic processes involved in aneurysmal dilation, thereby bringing about early hemorrhage from a preexisting lesion.