MISLEADING PARAFALCINE MASS: A CASE REPORT

Abstract

A parafalcine mass can be misdiagnosed with Giant intracranial aneurysm because of lack of specific radiological features. Giant aneurysm are rare comprising of 5 % of all intracranial aneurysm and commonly located on internal carotid artery and middle cerebral artery. A case which we describe, located on left distal anterior cerebral artery, is rare. A 53 old male presented with weakness in right lower limb associated with headache and dysarthria. On examination, Power of rt lower limb was 3/5 with normal vitals. On CT imaging, findings showed midline frontal parafalcine well defined mass with areas of hypodensity which conclude provisional diagnosis of parafalcine meningioma. MRI and CT Angiography was done for further confirmation where report was consistent with parafalcine meningioma. while operating following mid frontal craniotomy, findings are suggestive of thrombosed giant aneurysm arising from left distal anterior cerebral artery. Applying the clip at distal ACA prevented from possible unfortunate incidence and complete excision without complications. The postoperative period was uneventful with no new neurological deficit. This case is shared here as it is a rare kind of lesion which mislead surgeons during surgical intervention. So, clinician must be aware of the thrombosed aneurysm mimicking as intracranial neoplasms as differential diagnosis. It gives good result and patient satisfaction, without any neurological deficits.