Intracavernous iatrogenic aneurysm causing subarachnoid hemorrhage after removal of intracranial tumor, treated by coil embolizatioin

We describe a rare case of subarachnoid hemorrhage due to a ruputured iatrogenic traumatic aneurysm in the cavernous carotid artery, caused by injury during surgery for skull base meningioma that was performed 2 years ago. A 64-year-old woman underwent craniotomy for resection of meningioma of the right sphenoid ridge. During surgery, venous bleeding from the cavernous sinus was easily controlled by packing. Tumor infiltration into the artery had not occurred, and total resection was successfully performed. Two years later, the patient was admitted to our hospital for subarachnoid hemorrhage, without clinical signs of carotid cavernous fistula. Angiography displayed an aneurysm in the cavernous portion of the right carotid artery, which had not been detected on a previous angiogram. The aneurysm was successfully embolized with a GDC via an endovascular approach. Three months later, the residual aneurysm became enlarged and aneurysmal embolization was performed for a second time. Follow-up angiography was performed 7 months after initial embolization, and revealed complete packing.