Surgical Treatment of an Intracranial Anterior Ethmoidal Aneurysm: Case Report, Literature Review and Surgical Video

Abstract Background Anterior ethmoid aneurysms are rare with five cases of intracranial rupture and three cases of life-threatening epistaxis described in recent literature. We present a case of an intracranial ruptured anterior ethmoid aneurysm treated surgically with favorable outcome. Case description A 64-year-old male presenting with a headache was found to have a right frontal intracranial hemorrhage with an associated 1.5 cm length x 1.8 cm maximal width anterior ethmoidal artery aneurysm. No definitive etiology of the aneurysm was identified. The aneurysm was treated utilizing a bifrontal craniotomy with interhemispheric microdissection, clip ligation and resection of the aneurysm dome for pathological analysis, which ruled out a mycotic etiology. He recovered uneventfully and returned to work with no identifiable neurological deficit. Conclusions Consistent with prior reports, intracranial, anterior ethmoidal artery aneurysm can occur in isolation without an associated vascular malformation. Based on literature review and this case, surgical ligation is considered effective and possibly superior over endovascular treatment due to the risk of injury to the orbital vascular supply with trans-arterial treatment.