{"id":"15bad604-30cb-4bbe-a789-c174835bbad1","slug":"microsurgical-clipping-of-an-unusual-progressive-enlarging-venous-aneurysm-associated-with-cerebral-proliferative-angiopathy","title":"Microsurgical clipping of an unusual progressive enlarging venous aneurysm associated with cerebral proliferative angiopathy","authors":["Erica Antunes Effgen","Mariano Teyssandier","Alejandro Benjamin Romero Leguina","Luis Alberto Nuñez del Arco Serrano","Galo Eduardo Sánchez Borrero","Feres Chaddad-Neto"],"abstract":"Background: Cerebral venous aneurysms are usually caused by abnormalities in the venous drainage system or alterations in the venous pressure, occurring in arteriovenous fistulas, developmental venous anomalies, arteriovenous malformations, and proliferative angiopathy. A rupture may represent a tragic event, since it may be associated with subarachnoid or intraparenchymal hemorrhage, edema and hydrocephalus, and hence, worsening of the quality of life. Case Description: A previously healthy 31-year-old female presenting with a lowering of consciousness level, with investigation examinations revealing intraventricular hemorrhage and a left frontal proliferative angiopathy. The patient gradually recovered after hydrocephalus emergency treatment followed by rehabilitation; however, follow-up examinations revealed the emergence of a venous aneurysm at a draining vein of the proliferative angiopathy into the inferior sagittal sinus. The aneurysm eventually increased and changed its shape, and black-blood magnetic resonance imaging revealed contrast enhancement on its wall. All these factors, in the context of a young patient with previous cerebral hemorrhage led to the decision of microsurgical clipping of the venous aneurysm, preceded by embolization of a distal branch of the right middle meningeal artery, for the purpose of diminishing the venous pressure and facilitating the surgical manipulation of the venous system. No clinical or neurological complications were observed after surgical treatment, and postoperative examinations indicated the exclusion of the aneurysm and preservation of the venous flow. Conclusion: This case highlights how the microsurgical treatment of an unusual enlarging cerebral venous aneurysm, along with preoperative endovascular therapy, may be effective and prevent complications of rupture in a young patient. 00:09 – Clinical presentation and imaging findings 03:19 – Rationale for the procedure, risks and potential benefits, and alternatives and why they were not chosen 04:33 – Surgical positioning, necessary equipment, and key surgical steps 04:47 – Surgical approach and interhemispheric fissure dissection 05:31 – Venous aneurysm dissection 06:18 – Clipping of the venous aneurysm 07:44 – Clip-wrapping 07:56 – Disease background 09:09 – Clinical and imaging outcome The research/study was approved by the Institutional Review Board at Ethics and Research Committee of the Federal University of São Paulo, number 89389625.3.0000.5505, dated June 06, 2025. The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. There is no conflict of interest. The authors confirm that there was no use of Artificial Intelligence (AI)-Assisted Technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. https://doi.org/10.25259/SNI_1409_2025 The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/neurovascular.png","publishDate":"2026-03-06T00:00:00.000Z","doi":"10.25259/SNI_1409_2025","categories":["Neurovascular","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/15bad604-30cb-4bbe-a789-c174835bbad1/pdf"}