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Khoa TV, Thuong TM, Quang PX, Thang TQ, Linh NN, Ngan PTT, Van PD, Duong PN, Duc NM. Spontaneous thrombosis of a large unruptured intracranial aneurysm causing ischemic stroke due to occlusion of the parent artery: A case report and literature review. Radiol Case Rep 2024; 19:3405-3410. [PMID: 38845629 PMCID: PMC11154116 DOI: 10.1016/j.radcr.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 06/09/2024] Open
Abstract
Spontaneous thrombosis of an unruptured large or giant saccular intracranial aneurysm is a well-known phenomenon and can cause ischemic stroke (IS), which is a rare event. The possible pathogenic mechanisms of IS include distal embolic occlusion secondary to migration of the intra-aneurysmal thrombus, occlusion of the parent artery lumen caused by the retrograde extension of the aneurysmal thrombosis, external compression of the parent artery due to the increased aneurysmal mass effect. Among these, IS due to simultaneous thromboses of the aneurysm and its parent artery is extremely rare, with only a few cases reported in the literature. Herein, we present a case of a 18-year-old woman who suffered an acute IS, attribute to spontaneous complete thrombosis of an unruptured large saccular aneurysm of the right middle cerebral artery with occlusion of the parent artery, and we review the literature simultaneously.
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Affiliation(s)
- Ta Vuong Khoa
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Truong Minh Thuong
- Department of Radiology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Phan Xuan Quang
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Tran Quyet Thang
- Department of Radiology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Nguyen Nhut Linh
- Department of Radiology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Pham-Thi Thu Ngan
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Phan Dinh Van
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Phi Ngoc Duong
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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2
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Wang MX, Nie QB. Giant cavernous aneurysms occluded by aneurysmal thrombosis, calcification, parent artery occlusion: A case report and review of literature. World J Clin Cases 2024; 12:2822-2830. [PMID: 38899288 PMCID: PMC11185339 DOI: 10.12998/wjcc.v12.i16.2822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA, continuously progressed aneurysmal thrombosis, complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery (RICA). CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital. She had been diagnosed with a GIA [30 mm (axial) × 38 mm (coronal) × 28 mm (sagittal)] containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging (MRI), enhanced MRI, and magnetic resonance angiography more than 14 years ago. Later, with slow growth of the cavernous carotid GIA, aneurysmal thrombosis progressed continuously, spontaneous occlusion of the RICA, complete aneurysmal calcification, and occlusion of the GIA occurred gradually. She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage. As a result, she was left with severe permanent sequelae from the injuries to the right cranial nerves II, III, IV, V1/V2, and VI. CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery (ICA) induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification. However, nowadays, it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA, mainly caused by the mass effect of the cavernous carotid GIAs.
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Affiliation(s)
- Ming-Xi Wang
- School of Medicine, Huaqiao University, Xiamen 361021, Fujian Province, China
| | - Qing-Bin Nie
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
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Jha VC, Jain R, Sinha VS, Kumar N, Verma G, Dhage N. Spontaneous thrombosis and calcification of giant cavernous carotid artery aneurysm: A rare case and management insights. Surg Neurol Int 2024; 15:98. [PMID: 38628510 PMCID: PMC11021061 DOI: 10.25259/sni_805_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background Giant cavernous carotid artery aneurysms (>25 mm) are rare (3-5%), with some prone to spontaneous thrombosis (10-20% complete). We present a unique case of one of the largest aneurysms spontaneously thrombosing and calcifying. Case Description A 57-year-old with persistent right-sided headaches had a substantial hyperdense mass in the right middle cranial fossa, eroding petrous bone. Magnetic resonance imaging and digital subtraction angiography revealed a giant cavernous segment fusiform aneurysm of the right internal carotid artery (ICA) with spontaneous thrombosis and distal ICA occlusion. Collateral circulation maintains the cerebral blood supply. Despite anatomical challenges, conservative management was chosen due to the patient's stability. Conclusion This case highlights the complex interplay between thrombosed giant aneurysms and affected vessels, with unique features such as cross-flow, calcification, and bone erosion. We advocate conservative management for stable cases, supported by literature, emphasizing vigilant follow-up. This expands the spectrum of aneurysm presentations and encourages further research into their dynamics.
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Affiliation(s)
- Vikas Chandra Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
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4
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Salih M, Young M, Shutran M, Taussky P, Ogilvy CS. Spontaneous Thrombosis of a Giant Cavernous Internal Carotid Artery Aneurysm and Parent Vessel Occlusion in a Patient With Bilateral Cavernous Internal Carotid Artery Aneurysms. Cureus 2023; 15:e35231. [PMID: 36968945 PMCID: PMC10033139 DOI: 10.7759/cureus.35231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
Spontaneous thrombosis of giant aneurysms is a well-reported phenomenon. However, reports of complete occlusion of the aneurysm and parent vessel are scarce. Here, we describe the case of a patient with spontaneous thrombosis of a giant cavernous internal carotid artery (ICA) aneurysm and occlusion of the ICA. A 59-year-old female initially presented with frequent headaches and was otherwise completely neurologically intact. Magnetic resonance angiography (MRA) demonstrated a giant, partially thrombosed right cavernous ICA aneurysm. She was also found to have a contralateral left-sided intracavernous aneurysm. Cerebral angiogram revealed a giant, partially thrombosed right cavernous segment ICA aneurysm measuring 27.1 x 32.4 mm with slow, turbulent flow within the lesion. The patient was started on aspirin 325 mg and a dexamethasone taper with plans for follow-up flow diversion for treatment of the right cavernous ICA aneurysm. The patient presented three months later with worsening headaches, and on examination was found to have anisocoria (right > left) with a nonreactive right pupil as well as cranial nerve III/IV palsies, and facial edema. There was no evidence of intracranial hemorrhage or ischemia seen on head computed tomography (HCT). The diagnostic cerebral angiogram demonstrated complete occlusion of the right ICA at the carotid bifurcation with no filling of the giant right cavernous ICA aneurysm and a stable left cavernous ICA aneurysm. Although the exact mechanism of simultaneous thrombosis of the aneurysm and its parent artery remains unclear, it is likely due to stagnant flow. The presence of cranial nerve palsies was most likely secondary to acute edema of the lesion after thrombus formation. There was no evidence of ischemic symptoms due to collateral flow across a patent anterior communicating artery.
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Abousedu YA, Saleem A, Alenezi S, Bosnjakovic P, Lazovic L, Alsheikh TM. Spontaneous thrombosis of a giant cavernous-carotid aneurysm with simultaneous ipsilateral complete parent artery occlusion: a rare phenomenon and review of the literature. Arch Clin Cases 2023; 10:21-28. [PMID: 36814678 PMCID: PMC9940282 DOI: 10.22551/2023.38.1001.10234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Cavernous-carotid artery (CCA) aneurysms represent about 3-5% of all intracranial aneurysms. Spontaneous thrombosis of a CCA aneurysm with simultaneous occlusion of its parent vessel is an extremely rare phenomenon with few reported cases in the literature offering different management strategies. A 54-year-old Asian female presented with a one day-history of painless left eye conjunctival injection, proptosis, and features of cavernous sinus syndrome (cranial nerve III, IV, V1, V2, and VI palsies). Imaging revealed a giant thrombosed CCA aneurysm measuring 3.6cmx3.4cm with complete thrombosis of the left cervical internal carotid artery (ICA) and adequate collaterals from the anterior and posterior communicating artery and branches of the left external carotid artery. Management was conservative with antiplatelet therapy and close clinical-radiological follow-ups. The outcome was satisfactory. Data in the literature on this condition is limited due to its exceedingly rare occurrence. The majority of patients do well via a conservative approach and surgery is rarely indicated. For clinically stable patients, especially those with adequate collateral circulation and tolerance to Balloon Test Occlusion, we advocate for a conservative approach and initiation of anti-platelet therapy to treat these patients. Emphasis is needed on close serial clinical-radiological surveillance in these cases to monitor the propagation of the thrombus as well as the development of new and/or enlarging pre-existing aneurysms in the contralateral ICA circulation.
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Affiliation(s)
- Yousef A.I. Abousedu
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait,Corresponding Author: Yousef A. I. Abousedu. Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, PO Box: 25427 Safat 13115 Kuwait.
| | - Athary Saleem
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Saqer Alenezi
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Petar Bosnjakovic
- Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Lazar Lazovic
- Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Tarik M. Alsheikh
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
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Complete Basilar Artery Occlusion Following Ventriculoperitoneal Shunt Placement for Giant Aneurysm Complicated by Concurrent Obstructive Hydrocephalus: A Case Report. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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7
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A pediatric case of completely thrombosed giant cavernous carotid aneurysm with ipsilateral ICA occlusion mimicking an intra-axial cystic lesion: a case report and review of the literature. Childs Nerv Syst 2022; 38:1809-1812. [PMID: 35260912 DOI: 10.1007/s00381-022-05481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION There have been a few cases where completely thrombosed cavernous carotid artery (CCA) aneurysms have resembled neoplasms based on neuroimaging data, but no reports have been documented in children. CASE REPORT We describe an unusual pediatric case of a huge cavernous sinus mass mimicking a cystic neoplasm with peripheral rim enhancement on magnetic resonance imaging (MRI), where the surgery and subsequent histopathological investigation revealed that this mass was a completely thrombosed giant aneurysm of the CCA. The patient showed postoperatively no new neurological deficits and discharged a week later after surgery. CONCLUSIONS In this case report, we describe a pediatric case of a completely thrombosed giant CCA aneurysm with ipsilateral internal carotid artery (ICA) occlusion, which imitates an intra-axial cystic lesion on MRI.
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Yamagami K, Hatano T, Ando M, Chihara H, Ogura T, Suzuki K, Kondo D, Kamata T, Higashi E, Sakai S, Sakamoto H, Nagata I. Symptomatic Cavernous Internal Carotid Artery Aneurysm Complicated by Simultaneous Rapid Growth of the Intra-aneurysmal and Parent Artery Thromboses. NMC Case Rep J 2022; 8:177-182. [PMID: 35079460 PMCID: PMC8769381 DOI: 10.2176/nmccrj.cr.2020-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/03/2020] [Indexed: 11/20/2022] Open
Abstract
Cavernous internal carotid artery (ICA) aneurysm complicated by simultaneous and spontaneous formation of thromboses in the aneurysm and the parent artery is a rare clinical condition. Although the majority of patients have good outcomes, some patients experience severe ischemic stroke. Here, we report a case of symptomatic large cavernous ICA aneurysm complicated by rapid growth of an intra-aneurysmal thrombosis with simultaneous parent artery thrombosis. A 68-year-old female presented with sudden-onset diplopia, right ptosis, right conjunctival hyperemia, and paresthesia of the right face. Magnetic resonance imaging (MRI) and digital subtract angiography (DSA) revealed the presence of a large partially thrombosed aneurysm in the cavernous portion of the right ICA. We planned endovascular embolization using a flow-diverting (FD) stent. Dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel was started 2 weeks prior to treatment. Although the neurological state was stable, DSA conducted on the day of the endovascular treatment showed rapid growth of an intra-aneurysmal thrombosis and de novo thrombosis in the parent artery. Direct aspiration was performed via a distal support catheter with proximal blood flow arrest using a balloon-guide catheter, and the FD stent was successfully deployed. The patient’s symptoms improved postoperatively and DSA obtained 12 months after the procedure confirmed complete occlusion of the aneurysm. Although the exact mechanism of simultaneous thrombosis formation of the aneurysm and its parent artery remains unclear, it is important to recognize that rapid growth of the thrombosis increases the risk of ischemic stroke.
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Affiliation(s)
- Keitaro Yamagami
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Taketo Hatano
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Mitsushige Ando
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Hideo Chihara
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takenori Ogura
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Keita Suzuki
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Daisuke Kondo
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takahiko Kamata
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Eiji Higashi
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Shota Sakai
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Hiroki Sakamoto
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Izumi Nagata
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
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9
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Shimizu Y, Miyashita K, Oikawa N, Kobayashi M, Tohma Y. Ring enhanced aneurysm due to vasa vasorum of aneurysm wall mimicking a metastatic brain tumor. Surg Neurol Int 2021; 12:64. [PMID: 33654567 PMCID: PMC7911137 DOI: 10.25259/sni_582_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background A spherical intracranial mass can be occasionally misdiagnosed due to the lack of typical radiographic features. Completely thrombosed intracranial aneurysms (CTIA) are uncommon, but a possible differential diagnosis must be considered to guarantee the best surgical approach for these lesions. Case Description Here, we report an extremely rare case of a right frontal mass mimicking a brain tumor, in which the surgery unveiled a CTIA of the right middle cerebral artery (MCA). A 56-year-old woman presented with right hemiparesis and mild headache. Magnetic resonance imaging (MRI) revealed a right frontal mass with peripheral edema. The lesion enhanced on initial and follow-up MRI of the brain. Subsequent vascular studies and metastatic workup were negative. A temporal craniotomy with neuronavigation (Brain Lab AG, Germany) was performed and an intraoperative diagnosis of a thrombosed aneurysm along the branch of the MCA was established. The aneurysm was successfully trapped and resected. The patient did not exhibit any postoperative neurological deficits. Conclusion This is the rare report of a ring enhanced completely thrombosed aneurysm due to vasa vasorum which is misdiagnosed as metastatic brain tumor. In case of an intracranial ring enhanced mass with signs of intralesional hemorrhage and peripheral edema, CTIA should be considered as a possible differential diagnosis.
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Affiliation(s)
- Yu Shimizu
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan
| | | | - Nozomu Oikawa
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Masaaki Kobayashi
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Yasuo Tohma
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan
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10
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Chihi M, Jabbarli R, Gembruch O, Teuber-Hanselmann S, Darkwah Oppong M, Pierscianek D, Radbruch A, Glas M, Stettner M, Sure U. A rare case of a completely thrombosed bilobed giant intracranial aneurysm of the anterior cerebral artery with spontaneous parent vessel thrombosis: case report. BMC Neurol 2019; 19:297. [PMID: 31759385 PMCID: PMC6875162 DOI: 10.1186/s12883-019-1529-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
Background A huge spherical intracranial mass can sometimes be misdiagnosed, due to the lack of typical radiographic features. Thrombosed giant intracranial aneurysms (GIAs) are an uncommon but still a possible differential diagnosis that must be kept in mind to guarantee the best surgical approach and resection of the lesion. We describe an extremely rare case of a huge bifrontal mass mimicking a cystic echinococcosis, in which the surgery unveiled a completely thrombosed GIA of the left anterior cerebral artery (ACA). Case presentation A 61-year-old patient complained about intermittent weakness of the right leg, mild holocephalic headache, beginning cognitive deficits and lethargy. Magnetic resonance imaging (MRI) showed a huge partially calcified and bilobed frontal mass with peripheral edema. Based on a time-resolved angiography with interleaved Stochastic trajectories MRI (TWIST-MRI), a vascular origin of the lesion was considered unlikely. Therefore, the surgery was performed under the suspicion of a cystic echinococcosis but revealed a bilobed GIA of the left ACA with a parent vessel thrombosis. Although only a limited left frontal craniotomy was performed, a proximal control of the parent vessel could be ensured, and the aneurysm was successfully clipped. The patient showed postoperatively no new neurological deficits. Conclusions Completely thrombosed GIAs with parent vessel thrombosis are rare lesions that might be misdiagnosed if typical radiographic features are missing. Thus, in case of an intracranial spherical mass with signs of intralesional hemorrhage and mural calcifications, presence of a completely thrombosed GIA should be considered as a possible differential diagnosis.
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Affiliation(s)
- Mehdi Chihi
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sarah Teuber-Hanselmann
- Institute of Neuropathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Daniela Pierscianek
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexander Radbruch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Glas
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mark Stettner
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Extracranial–Intracranial High-Flow Bypass for Giant Ruptured Paraclinoid Aneurysm with Concomitant Bilateral Internal Carotid Artery Stenotic Dissection. World Neurosurg 2018; 117:265-270. [DOI: 10.1016/j.wneu.2018.06.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 12/26/2022]
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12
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Das KK, Singh G, Pandey S, Bhaisora KS, Jaiswal A, Behari S. Completely Thrombosed Giant Intracranial Aneurysm with Spontaneous Thrombosis of the Parent Artery: Is It Nature's Divine Intervention and a Self-Cure? World Neurosurg 2018; 118:132-138. [PMID: 30026148 DOI: 10.1016/j.wneu.2018.07.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although partial thrombosis is common with intracranial aneurysms, complete aneurysmal thrombosis is extremely rare. An even rarer and seldom reported phenomenon is the spontaneous complete occlusion of the parent artery in the presence of a thrombosed aneurysm. Given the unclear natural history of this phenomenon, therapeutic decision making may be rather difficult. Here we report a case of right cavernous carotid artery aneurysm with spontaneous right internal carotid artery (ICA) thrombosis in a 45-year-old man. CASE DESCRIPTION Our patient presented almost 1 month after an episode of sudden-onset severe holocranial headache associated with vomiting that had resolved completely within 2 days. He was neurologically intact at the time of presentation. A computed tomography (CT) scan done at the time of ictus showed a rounded hyperdensity with the epicenter at the right parasellar region along with nonvisualization of the ipsilateral ICA on CT angiography. Magnetic resonance imaging (MRI) suggested a diagnosis of a completely thrombosed right cavernous segment ICA aneurysm. Intra-arterial angiography confirmed a complete ipsilateral ICA thrombosis and a good arterial cross-flow from the left side to the bilateral anterior and middle cerebral artery territories. We started the patient on oral aspirin and a close clinicoradiologic follow-up after having decided against any active intervention. CONCLUSIONS Spontaneous thrombosis of an intracranial aneurysm and the parent artery is rare, with only a few cases reported in the literature. In the absence of symptoms and adequate collateral circulation, these patients are perhaps best managed conservatively.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Gagandeep Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Satyadeo Pandey
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Awadhesh Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Pop R, Chibarro S, Manisor M, Proust F, Beaujeux R. Republished: Spontaneous thrombosis of a basilar tip aneurysm after ventriculoperitoneal shunting. J Neurointerv Surg 2015; 8:e34. [DOI: 10.1136/neurintsurg-2015-011841.rep] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/04/2022]
Abstract
We present a case of a large unruptured basilar tip aneurysm with concomitant hydrocephalus. Complete thrombosis of the aneurysm was observed after ventriculoperitoneal shunting. Analyzing preoperative and postoperative MRI and DSA images, we identified reduced intracranial pressure and widening of the aneurysm–artery inclination angle as possible factors influencing spontaneous thrombosis. To the best of our knowledge, this is the first report of aneurysm thrombosis occurring after CSF diversion.
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14
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Pop R, Chibarro S, Manisor M, Proust F, Beaujeux R. Spontaneous thrombosis of a basilar tip aneurysm after ventriculoperitoneal shunting. BMJ Case Rep 2015; 2015:bcr-2015-011841. [PMID: 26150627 DOI: 10.1136/bcr-2015-011841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a large unruptured basilar tip aneurysm with concomitant hydrocephalus. Complete thrombosis of the aneurysm was observed after ventriculoperitoneal shunting. Analyzing preoperative and postoperative MRI and DSA images, we identified reduced intracranial pressure and widening of the aneurysm-artery inclination angle as possible factors influencing spontaneous thrombosis. To the best of our knowledge, this is the first report of aneurysm thrombosis occurring after CSF diversion.
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Affiliation(s)
- Raoul Pop
- Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
| | - Salvatore Chibarro
- Department of Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - Monica Manisor
- Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
| | - Francois Proust
- Department of Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - Remy Beaujeux
- Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
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15
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Sastri SB, Sadasiva N, Pandey P. Giant cavernous carotid aneurysm with spontaneous ipsilateral ICA occlusion: Report of 2 cases and review of literature. J Neurosci Rural Pract 2013; 4:S113-6. [PMID: 24174776 PMCID: PMC3808038 DOI: 10.4103/0976-3147.116439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Giant aneurysms of the cavernous carotid artery are rare entities which present predominantly with features of compression of the adjacent neural structures, most commonly the III, IV, VI and V cranial nerves. Historically, treatment options included occlusion of the feeding vessel, direct surgery on the aneurysm, bypass procedures and in recent times, the use of endovascular devices. While intramural thrombus formation is commonly seen in giant aneurysms, we present 2 cases of giant cavernous aneurysms which on evaluation were found to have spontaneous occlusion of the feeding internal carotid artery secondary to thrombus formation, and review the available literature regarding the same.
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Baldawa SS, Pendharkar H, Menon GR, Nair SR. Case report: Thrombosed giant cavernous carotid artery aneurysm secondary to cervical internal carotid artery dissection: An unusual entity. Indian J Radiol Imaging 2011; 21:225-7. [PMID: 22013300 PMCID: PMC3190497 DOI: 10.4103/0971-3026.85373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Spontaneous thrombosis of a giant intracranial aneurysm with parent artery occlusion is known. The exact mechanism is however unclear and various theories have been proposed. We present an unusual case of an angiographically documented cervical internal carotid artery (ICA) dissection, which led to total occlusion of the ICA distal to the dissected site, with acute cessation of forward blood flow. This resulted in acute upstream thrombosis of the giant cavernous carotid artery aneurysm and an acute cavernous sinus syndrome-like presentation.
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Affiliation(s)
- Sachin S Baldawa
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Jayakumar PN, Ravishankar S, Balasubramaya KS, Chavan R, Goyal G. Disappearing saccular intracranial aneurysms: do they really disappear? Interv Neuroradiol 2007; 13:247-54. [PMID: 20566116 DOI: 10.1177/159101990701300304] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Accepted: 08/14/2007] [Indexed: 11/17/2022] Open
Abstract
SUMMARY Evolution and natural history of cerebral aneurysms is a dynamic process. Spontaneous regression in size or complete disappearance of an aneurysm is a known phenomenon, more commonly noted in giant intracranial aneurysms. However, reappearance or regrowth of such aneurysms is rare with few anecdotal reports. We report a series of four cases including one giant aneurysm, which either disappeared or regressed on sequential angiograms. Regrowth or reappearance of two of these previously disappeared or regressed aneurysms was noted and endovascularly treated while the other two cases are being followed up. The decision to follow up was crucial considering the nature of the aneurysms to change in morphology under the influence of various hemodynamic factors.
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Affiliation(s)
- P N Jayakumar
- Department of Neuroimaging and Interventional Radiology, National Institute of mental health and neurosciences, Bangalore, India -
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