To investigate the clinical characteristics of traumatic and iatrogenic intracranial pseudoaneurysms, and the methods and effects of endovascular treatment.

The clinical features of both six cases of traumatic brain injury and one case of iatrogenic intracranial pseudoaneurysm, who were hospitalized in the department of neurosurgery in Ganzhou hospital affiliated to Nanchang University from October 2012 to March 2020, were retrospectively analyzed. The related endovascular treatment was also evaluated, including the methods, the effects, the recurrence, the complications, and the follow-up.

All the six cases of traumatic intracranial pseudoaneurysm suffered skull base fractures and subarachnoid hemorrhage after trauma, showing a relationship between pseudoaneurysm and fractures.　Among six cases of traumatic intracranial pseudoaneurysm, there were two cases of internal carotid artery cavernous segment pseudoaneurysm, three cases of paraclinoid pseudoaneurysm, and one case of a pseudoaneurysm which was located in the intracranial segment of the middle meningeal artery. All these six cases were treated with endovascular treatment, including one case with coil embolization, three cases with multi stent assisted embolization, one case with Onyx embolization, and one case with iatrogenic intracranial pseudoaneurysm, who was treated with multi-stent assisted embolization after dynamic reexamination after trauma. All seven cases with endovascular treatment immediately achieved no aneurysm development (Raymond grade 1). Two cases recurred after operation, including one case with simple coil embolization, recurrent nasal bleeding, and stent assisted coil embolization again after recurrence; the other case with stent assisted embolization was found recurrent three months after DSA, therefore with spring coil filling again. Among the seven patients treated with endovascular treatment, only one patient had cerebral infarction after operation, which was temporal parietal lobe infarction on the aneurysm side, with 3 points of mRS (modified Rankin scale) and mild hemiplegia at discharge. The mRS of six patients with traumatic pseudoaneurysms were 0 in 4 cases and 3 in 2 cases. One of the latter was able to work normally, with a decrease from 3 points to 1 point after 2 years of rehabilitation, and the other one was still recovering, with a slight decrease from 3 points to 2 points half a year later. The mRS of iatrogenic intracranial pseudoaneurysm was 0 at discharge. There were no deaths. The patients were followed up from 6 months to 8 years. Two cases were reexamined by DSA 1 year later, the other four cases by CTA or MRA in the outpatient one year later. No recurrence was found. Six cases were followed up by telephone, and the other one was lost 3 months later.

Early detection and early treatment are very important for traumatic and iatrogenic intracranial pseudoaneurysms. Based on both the patient's specific condition and the equipment accessibility and the technical feasibility of the hospital, the appropriate endovascular treatment method can achieve good results.