• Kunal P Raygor, Michael A Mooney, Laura A Snyder, Michael R Levitt, Felipe C Albuquerque, and Robert F Spetzler.
• Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
• Neurosurgery. 2015 Sep 28.

BackgroundExternal 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.ObjectiveTo present our management strategy of a unique case of pseudoaneurysm formation in the context of the medical literature on these rare complications.MethodsAn 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.ResultsThe pseudoaneurysm was successfully treated with surgical resection.ConclusionPseudoaneurysm 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.AbbreviationsACA, anterior cerebral arteryEVD, external ventricular drain.

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