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Koneru M, Badger C, Turtz AR, Shaikh H. Combining Endovascular Coiling and Open Evacuation for a Delayed-Onset Ruptured Post-traumatic Pseudoaneurysm of the Distal Paracentral Pericallosal Artery Branch. Cureus 2023; 15:e43880. [PMID: 37746416 PMCID: PMC10511349 DOI: 10.7759/cureus.43880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Cerebrovascular pseudoaneurysm development and rupture is a rare, delayed sequelae of trauma. We present a case of a female patient in her sixties who presented after a fall without evidence of vascular injury on imaging. However, after one week, repeat imaging due to an abrupt change in mental status revealed a ruptured pseudoaneurysm, which was treated with a combination of coil embolization and open surgical evacuation of associated intracranial hematoma. This case illustrates the importance of continued surveillance beyond the acute traumatic period to identify late-onset complications in trauma patients requiring emergent treatment.
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Affiliation(s)
- Manisha Koneru
- Neurointerventional Surgery, Cooper Medical School of Rowan University, Camden, USA
| | - Clint Badger
- Neurosurgery, Cooper University Health Care, Camden, USA
| | - Alan R Turtz
- Neurosurgery, Cooper University Health Care, Camden, USA
| | - Hamza Shaikh
- Neurointerventional Surgery, Cooper University Health Care, Camden, USA
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2
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Fry L, Brake A, Heskett CA, LeBeau G, De Stefano FA, Alkiswani AR, Lei C, Le K, Peterson J, Ebersole K. Endovascular Management of Pediatric Traumatic Intracranial Pseudoaneurysms: A Systematic Review and Case Series. World Neurosurg 2023; 176:213-226. [PMID: 37059359 DOI: 10.1016/j.wneu.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE This study aims to systematically review the management and outcomes of pediatric patients who develop intracranial pseudoaneurysm (IPA) following head trauma or iatrogenic injury. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was performed. Additionally, a retrospective analysis was conducted on pediatric patients who underwent evaluation and endovascular treatment for IPA originating from head trauma or iatrogenic injury at a single institution. RESULTS Two hundred twenty-one articles in the original literature search. Fifty-one met inclusion criteria resulting in a total of 87 patients with 88 IPAs including our institution. Patients ranged in age from 0.5 months to 18 years. Parent vessel reconstruction was used as first-line treatment in 43 cases, parent vessel occlusion in 26, and direct aneurysm embolization (DAE) in 19. Intraoperative complications were observed in 3.00% of procedures. Complete aneurysm occlusion was achieved in 89.61% of cases. 85.54% of cases resulted in favorable clinical outcomes. The mortality rate after treatment was 3.61%. The DAE group had higher rates of aneurysm recurrence than other treatment strategies (P = 0.009). Patients with SAH had overall worse outcomes compared to patients who did not (P = 0.024). There were no differences in favorable clinical outcomes (P = 0.274) or complete aneurysm occlusion (P = 0.13) between primary treatment strategies. CONCLUSIONS IPAs were successfully obliterated, and favorable neurological outcomes were achieved at a high rate regardless of primary treatment strategy. DAE had a higher rate of recurrence than the other treatment groups. Each described treatment method in our review is safe and viable for the treatment of IPAs in pediatric patients.
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Affiliation(s)
- Lane Fry
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Aaron Brake
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Cody A Heskett
- The University of Kansas School of Medicine, Kansas City, Kansas.
| | - Gabriel LeBeau
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas
| | | | - Catherine Lei
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Kevin Le
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas
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3
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Takeda K, Oda K, Fukumoto H, Kobayashi H, Morishita T, Takemoto K, Iwaasa M, Abe H. Repeated coil embolization of traumatic basilar artery pseudoaneurysm accompanied by bilateral traumatic internal carotid artery stenosis following severe head injury in a pediatric patient: A case report and literature review. Surg Neurol Int 2023; 14:199. [PMID: 37404524 PMCID: PMC10316180 DOI: 10.25259/sni_267_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: 03/27/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Background Few cases of pediatric traumatic intracranial aneurysms (pTICAs) in the posterior circulation involving the basilar artery (BA) following severe head trauma have been reported. Here, we describe a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic internal carotid artery (ICA) stenosis following blunt head trauma. Case Description A 16-year-old boy presented to our emergency department after being hit by a car. The patient was initially diagnosed with multiple skull base fractures underlying traumatic subarachnoid hemorrhage and left acute epidural hematoma. Seven days following emergency craniectomy, magnetic resonance imaging revealed bilateral ICA stenosis, BA stenosis, and BA pseudoaneurysm. We decided to perform coil embolization, resulting in body filling and a volume embolization ratio of 15.7%. Twenty-eight days after coil embolization, digital subtraction angiography revealed aneurysmal rupture. We performed repeated coil embolization, resulting in body filling and a volume embolization ratio of 20.9%. Conclusion We reported a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic ICA stenosis following a severe head injury treated with repeated coil embolization. Considering the risk of further brain injury due to high incidence of rupture, early vascular survey and appropriate treatment may be the most important prognostic factors in pTICAs.
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Affiliation(s)
| | - Kazunori Oda
- Corresponding author: Kazunori Oda, Department of Neurosurgery, Fukuoka University, Fukuoka, Japan.
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Yeap MC, Chung MW, Chen CT. Traumatic aneurysm at the superior cerebellar artery: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21577. [PMID: 35855486 PMCID: PMC9281434 DOI: 10.3171/case21577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Traumatic aneurysms at the superior cerebellar arteries after head injury are extremely rare and may be overlooked. Rupture of these aneurysms can cause fatal intracranial hemorrhages; thus, early identification of the entity helps prevent detrimental outcomes. OBSERVATIONS A patient suffered from sudden severe headache and decreased consciousness level several weeks after a blunt head injury. He received surgery to remove a progressive enlarging subdural hematoma. The diagnosis of a traumatic aneurysm at the superior cerebellar artery was delayed, made only after a recurrent subdural hemorrhage occurred. He received another surgery to obliterate the aneurysm. LESSONS The patient could have been treated earlier if traumatic aneurysm had been suspected in the beginning. In addition to the case, the authors also reviewed the literature to clarify the pathophysiology, clinical presentation, diagnosis, and management of the disease.
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Affiliation(s)
| | - Meng-Wu Chung
- General Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Palmieri M, Pesce A, Zancana G, Armocida D, Maiese A, Cirelli C, Santoro A, Frati P, Fineschi V, Frati A. Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity. Neurosurg Rev 2021; 45:1019-1029. [PMID: 34608549 PMCID: PMC8976800 DOI: 10.1007/s10143-021-01657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
Traumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.
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Affiliation(s)
- Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.
| | - Alessandro Pesce
- Santa Maria Goretti Hospital, Neurosurgery Division, Latina, Italy
| | - Giuseppa Zancana
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Daniele Armocida
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Carlo Cirelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Unit of Interventional Neuroradiology, "Sapienza" University of Rome, Umberto I University Hospital, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Alessandro Frati
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.,IRCCS "Neuromed", Pozzilli, IS, Italy
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Grover PJ, Harris L, Qureshi AM, Rennie A, Robertson F, James G. Occult posterior inferior cerebellar artery dissection requiring endovascular treatment following pediatric head trauma: case report. J Neurosurg Pediatr 2021; 27:643-648. [PMID: 33836497 DOI: 10.3171/2020.11.peds18324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
This is the eighth case report of a pediatric dissecting posterior inferior cerebellar artery aneurysm. The authors present the case of a 13-year-old boy who presented with posttraumatic posterior fossa subdural, subarachnoid, and intraventricular hemorrhage with hydrocephalus. Initial vascular imaging findings were negative; however, a high level of suspicion is necessary. The aneurysm was identified on day 20, after recurrence of hydrocephalus, and was treated with endovascular vessel sacrifice. The patient made a good recovery. It is important to consider arterial dissection in pediatric traumatic brain injury, especially with suspicious findings on initial CT scan and clinical presentation out of proportion to the mechanism of injury. Delayed vascular imaging is imperative for appropriate management.
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Affiliation(s)
- Patrick J Grover
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Lauren Harris
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Ayman M Qureshi
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Adam Rennie
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Fergus Robertson
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Greg James
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
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Traumatic Subarachnoid Hemorrhage and Subdural Hematoma Due to Acute Rebleeding of a Pseudoaneurysm with Dural Arteriovenous Fistula Between Inferolateral Trunk of the Internal Carotid Artery and Middle Cerebral Vein. World Neurosurg 2020; 143:315-318. [PMID: 32781149 DOI: 10.1016/j.wneu.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND According to previous reports, pseudoaneurysms that are concomitant with a dural arteriovenous fistula (dAVF) are associated with penetrating trauma, blunt trauma, and skull fractures. Moreover, dAVFs between the inferolateral trunk of the internal carotid artery and middle cerebral vein are a rare disease manifestation. Pseudoaneurysms concomitant with dural arteriovenous fistulas (dAVF) are rare and traumatic pseudoaneurysms with dAVF typically developed slowly with less rebleeding than isolated traumatic aneurysms. CASE DESCRIPTION Here, we report an extremely rare case of a traumatic pseudoaneurysm with a dAVF between the inferolateral trunk and middle cerebral vein. The traumatic pseudoaneurysm presented with acute pseudoaneurysm formation and rebleeding within 1 day of the trauma and was managed with direct surgery. CONCLUSIONS The traumatic pseudoaneurysm was completely obliterated by surgical clipping, followed by decompressive craniectomy and postoperative coma therapy with propofol. Resulting from these surgical and postoperative treatments, 56 days after the operation the patient recovered fully and did not present any neurologic deficits.
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Hou K, Li G, Wang X, Xu K, Yu J. Endovascular Treatment for Peripheral Superior Cerebellar Artery Aneurysms: Current State and Future Considerations. World Neurosurg 2019; 127:423-433. [DOI: 10.1016/j.wneu.2019.04.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/27/2022]
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Subarachnoid haemorrhage secondary to traumatic intracranial aneurysm of the posterior cerebral circulation: case series and literature review. Acta Neurochir (Wien) 2016; 158:1731-40. [PMID: 27364895 PMCID: PMC4980416 DOI: 10.1007/s00701-016-2865-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/02/2016] [Indexed: 12/03/2022]
Abstract
Background To identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Subjects included 26 patients aged 3–54 (mean 24.8). Methods Case series and literature search to identify all reported cases. Results In our series, two of three cases were fatal as a result of rebleed, and one case had a good outcome with no deficit, following prompt diagnosis and embolisation. Our key findings from the literature review were: 30.7 % of patients were age 16 and under; 88 % had an acute drop in consciousness, 46 % in a delayed manner; the mean time to diagnosis was 7.5 days; initial cerebrovascular imaging was normal in 23 %; the rebleed rate was 23 %; 61 % required emergency diversion of cerebrospinal fluid; 11 % developed vasospasm requiring treatment; 19.2 % had deficits that rendered them unable to live independently. The mortality rate was 27 %. Conclusions SAH from ruptured posterior circulation TICA is associated with significant morbidity and mortality. A high index of suspicion as well as prompt diagnosis, repeat imaging in selected cases, and treatment of any associated TICA can be crucial to a favourable outcome.
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Kim BC, Lee JI, Cho WH, Nam KH. Fatal Traumatic Subarachnoid Hemorrhage due to Acute Rebleeding of a Pseudoaneurysm Arising from the Distal Basilar Artery. J Korean Neurosurg Soc 2014; 56:428-30. [PMID: 25535522 PMCID: PMC4273003 DOI: 10.3340/jkns.2014.56.5.428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/25/2014] [Accepted: 08/18/2014] [Indexed: 11/27/2022] Open
Abstract
Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.
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Affiliation(s)
- Byung Chul Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kyoung Hyup Nam
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Rodríguez-Hernández A, Zador Z, Rodríguez-Mena R, Lawton MT. Distal Aneurysms of Intracranial Arteries: Application of Numerical Nomenclature, Predilection for Cerebellar Arteries, and Results of Surgical Management. World Neurosurg 2013; 80:103-12. [DOI: 10.1016/j.wneu.2012.09.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 08/21/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
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