Aneurysm formation and postcoiling recurrence in HIV-associated vasculopathy: illustrative case

Authors

Emmajane G. Rhodenhiser, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Christopher S. Graffeo, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Lea Scherschinski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Jacob F. Baranoski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Document Type

Article

Abstract

BACKGROUND: Human immunodeficiency virus (HIV) infection is linked with an uncommon vasculopathy syndrome, increasing the susceptibility of infected individuals to develop aneurysms across systemic vasculature, notably in the cerebral vasculature. Intracranial aneurysms have been detected in up to 14% of HIV-positive patients with neuroimaging, often manifesting in unusual locations or with atypical morphologies due to systemic pathophysiology. OBSERVATIONS: This case report describes a previously coiled middle cerebral artery sidewall aneurysm that subsequently recurred in an HIV-positive man in his late 20s, necessitating open treatment with microsurgical clip reconstruction, which was performed using a minipterional craniotomy and transsylvian approach. Intraoperative findings included diffuse cerebral dolichoectasia, a broad-necked recurrence of the M2 segment aneurysm, and a de novo A1 segment aneurysm. Both aneurysms were successfully treated with primary clipping reconstruction. The patient recovered well, with no new postoperative neurological deficits and radiographically confirmed obliteration of both aneurysms. LESSONS: Endovascular treatment of HIV-positive patients with cerebrovascular disease can be predisposed to failure, and such patients require close radiographic surveillance. The differential risk of recurrence by treatment modality is indeterminate; however, young HIV-positive patients with intracranial aneurysms can benefit from the preferential use of open clipping where equipoise exists. https://thejns.org/doi/10.3171/CASE24700.

Publication Date

3-3-2025

Publication Title

Journal of neurosurgery. Case lessons

E-ISSN

2694-1902

Volume

9

Issue

9

PubMed ID

40030146

Digital Object Identifier (DOI)

10.3171/CASE24700

Recommended Citation

Rhodenhiser, Emmajane G.; Graffeo, Christopher S.; Scherschinski, Lea; Baranoski, Jacob F.; Srinivasan, Visish M.; and Lawton, Michael T., "Aneurysm formation and postcoiling recurrence in HIV-associated vasculopathy: illustrative case" (2025). Neurosurgery. 2237.
https://scholar.barrowneuro.org/neurosurgery/2237