1
|
Theocharidou A, Spanou A, Alexandratou M, Michas V, Lamprou V, Psoma E, Finitsis S. An off-label use of flow-diverter stent as a successful treatment of a postoperative middle cerebral artery pseudoaneurysm. Radiol Case Rep 2023; 18:2219-2223. [PMID: 37123043 PMCID: PMC10139864 DOI: 10.1016/j.radcr.2023.03.020] [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: 01/13/2023] [Revised: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 05/02/2023] Open
Abstract
A pseudoaneurysm or false aneurysm is the result of the disruption of the vessel wall and the formation of a hematoma in communication with the vascular lumen, restrained by perivascular connective tissue. Intracranial pseudoaneurysms represent a rare entity mainly because of trauma, iatrogenic causes, infectious disease, radiation exposure, connective tissue disease and sometimes spontaneous occurrence. We present a 35-year-old female patient with a history of multiple low-grade glioma debulking surgeries. During the last procedure, laceration of the left middle cerebral artery (MCA) occurred with diffuse subarachnoid hemorrhage. Imaging studies showed the formation of a pseudoaneurysm of the left MCA which was successfully treated with the implantation of a flow diverter across the lesion neck and excellent mid- to long- term results. Flow diverter implantation may be a promising technique for the therapeutic management of cerebral pseudoaneurysms.
Collapse
|
2
|
Zheng Y, Lu Z, Shen J, Xu F. Intracranial Pseudoaneurysms: Evaluation and Management. Front Neurol 2020; 11:582. [PMID: 32733358 PMCID: PMC7358534 DOI: 10.3389/fneur.2020.00582] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/20/2020] [Indexed: 12/04/2022] Open
Abstract
Intracranial pseudoaneurysms account for about 1% of intracranial aneurysms with a high mortality. The natural history of intracranial pseudoaneurysm is not well-understood, and its management remains controversial. This review provides an overview of the etiology, pathophysiology, clinical presentation, imaging, and management of intracranial pseudoaneurysms. Especially, this article emphasizes the factors that should be considered for the most appropriate management strategy based on the risks and benefits of each treatment option.
Collapse
Affiliation(s)
- Yongtao Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Zheng Lu
- Department of Neurosurgery, Hai'an People's Hospital, Nantong, China
| | - Jianguo Shen
- Department of Neurosurgery, Second Affiliated Hospital of Jiaxiang University, Jiaxing, China
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.,Department of Neurosurgery, Kashgar Prefecture Second People's Hospital, Kashgar, China
| |
Collapse
|
3
|
Shah KJ, Jones AM, Arnold PM, Ebersole K. Intracranial pseudoaneurysm after intracranial pressure monitor placement. J Neurointerv Surg 2014; 8:e3. [PMID: 25520265 DOI: 10.1136/neurintsurg-2014-011410.rep] [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] [Accepted: 11/24/2014] [Indexed: 12/30/2022]
Abstract
Traumatic intracranial pseudoaneurysms are a rare but severe complication following arterial injury. Pseudoaneurysm formation can occur secondary to blunt or penetrating trauma or iatrogenic injury. We report a case of traumatic pseudoaneurysm secondary to placement of an intracranial pressure (ICP) monitor. A 27-year-old man was involved in a motorcycle accident resulting in multiple intracranial hemorrhages. The patient underwent craniectomy and placement of an ICP monitor. 17 days later he developed dilation of his left pupil, with imaging demonstrating a new hemorrhage in the vicinity of the previous ICP monitor. A cerebral angiogram confirmed a left-sided distal M4 pseudoaneurysm which was treated by n-butyl cyanoacrylate embolization. Intracranial pseudoaneurysm formation following neurosurgical procedures is uncommon. Delayed intracranial hemorrhage in a region of prior intracranial manipulation, even following a procedure as 'routine' as placement of an ICP monitor, should raise the suspicion for this rare but potentially lethal complication.
Collapse
Affiliation(s)
- Kushal J Shah
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Aaron M Jones
- Department of Neurosurgery, University of Kansas, Kansas City, Kansas, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas, Kansas City, Kansas, USA
| | - Koji Ebersole
- Department of Neurosurgery, University of Kansas, Kansas City, Kansas, USA
| |
Collapse
|
4
|
Shah KJ, Jones AM, Arnold PM, Ebersole K. Intracranial pseudoaneurysm after intracranial pressure monitor placement. BMJ Case Rep 2014; 2014:bcr-2014-011410. [PMID: 25498805 DOI: 10.1136/bcr-2014-011410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Traumatic intracranial pseudoaneurysms are a rare but severe complication following arterial injury. Pseudoaneurysm formation can occur secondary to blunt or penetrating trauma or iatrogenic injury. We report a case of traumatic pseudoaneurysm secondary to placement of an intracranial pressure (ICP) monitor. A 27-year-old man was involved in a motorcycle accident resulting in multiple intracranial hemorrhages. The patient underwent craniectomy and placement of an ICP monitor. 17 days later he developed dilation of his left pupil, with imaging demonstrating a new hemorrhage in the vicinity of the previous ICP monitor. A cerebral angiogram confirmed a left-sided distal M4 pseudoaneurysm which was treated by n-butyl cyanoacrylate embolization. Intracranial pseudoaneurysm formation following neurosurgical procedures is uncommon. Delayed intracranial hemorrhage in a region of prior intracranial manipulation, even following a procedure as 'routine' as placement of an ICP monitor, should raise the suspicion for this rare but potentially lethal complication.
Collapse
Affiliation(s)
- Kushal J Shah
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Aaron M Jones
- Department of Neurosurgery, University of Kansas, Kansas City, Kansas, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas, Kansas City, Kansas, USA
| | - Koji Ebersole
- Department of Neurosurgery, University of Kansas, Kansas City, Kansas, USA
| |
Collapse
|
5
|
Kim SS, Kang DH, Park H, Lee CH, Hwang SH, Jung JM, Han JW, Park IS. Short-Term Clinical and Angiographic Outcome in Child with Traumatic Pseudoaneurysm in A2 Segment of Anterior Cerebral Artery after Endovascular Treatment: Case Report. Korean J Neurotrauma 2014; 10:130-3. [PMID: 27169048 PMCID: PMC4852616 DOI: 10.13004/kjnt.2014.10.2.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 11/24/2022] Open
Abstract
Intracranial traumatic pseudoaneurysms are rare, and their vessel structures are immature and easy to disrupt, especially in children. Furthermore, it is difficult to diagnose and treat, which is a characteristic of traumatic pseudoaneurysm. In this study, the authors described a traumatic pseudoaneurysm in A2 segment of anterior cerebral artery, and the treatment with stent for structural stability of vessel.
Collapse
Affiliation(s)
- Seung-Soo Kim
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Dong-Ho Kang
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Hyun Park
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Chul-Hee Lee
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Soo-Hyun Hwang
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jin-Myung Jung
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jong-Woo Han
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - In Sung Park
- Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
| |
Collapse
|
6
|
Chen Z, Zhang J, Miao H, Niu Y, Feng H, Zhu G. Delayed rupture of iatrogenic cerebral pseudoaneurysms after neurosurgical procedures: report of two cases. Clin Neurol Neurosurg 2013; 115:1552-4. [PMID: 23369400 DOI: 10.1016/j.clineuro.2012.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/18/2012] [Accepted: 12/28/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | | | | | | | | | | |
Collapse
|
7
|
Abstract
Precision is the ultimate aim of stereotactic technique. Demands on stereotactic precision reach a pinnacle in stereotactic functional neurosurgery. Pitfalls are best avoided by possessing in-depth knowledge of the techniques employed and the equipment used. The engineering principles of arc-centered stereotactic frames maximize surgical precision at the target, irrespective of the surgical trajectory, and provide the greatest degree of surgical precision in current clinical practice. Stereotactic magnetic resonance imaging (MRI) provides a method of visualizing intracranial structures and fiducial markers on the same image without introducing significant errors during an image fusion process. Although image distortion may potentially limit the utility of stereotactic MRI, near-complete distortion correction can be reliably achieved with modern machines. Precision is dependent on minimizing errors at every step of the stereotactic procedure. These steps are considered in turn and include frame application, image acquisition, image manipulation, surgical planning of target and trajectory, patient positioning and the surgical procedure itself. Audit is essential to monitor and improve performance in clinical practice. The level of stereotactic precision is best analyzed by routine postoperative stereotactic MRI. This allows the stereotactic and anatomical location of the intervention to be compared with the anatomy and coordinates of the intended target, avoiding significant image fusion errors.
Collapse
Affiliation(s)
- Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, United Kingdom
| |
Collapse
|
8
|
Shoja MM, Tubbs RS, Cohen-Gadol AA. Acute formation of a pseudoaneurysm adjacent to a previously clipped anterior communicating artery aneurysm. Surg Neurol Int 2011; 2:56. [PMID: 21697973 PMCID: PMC3114371 DOI: 10.4103/2152-7806.80121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 04/06/2011] [Indexed: 11/08/2022] Open
Abstract
Background: Cerebral pseudoaneurysms, especially of the anterior communicating artery (ACoA), are rare. Case Description: Herein, the authors report a 66-year-old patient who underwent successful clip ligation of a small ruptured ACoA aneurysm. Eighteen days after surgery, he suffered from another episode of subarachnoid hemorrhage due to the rupture of a newly formed pseudoaneurysm adjacent to the previously clipped aneurysm. This pseudoaneurysm was treated through clip ligation as well. Conclusion: A pseudoaneurysm may rarely form adjacent to a previously clipped cerebral aneurysm and should be included in the differential diagnosis of recurrent subarachnoid hemorrhage. Potential mechanisms of formation and management strategies for this challenging problem will be discussed.
Collapse
Affiliation(s)
- Mohammadali M Shoja
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | |
Collapse
|
9
|
Hjortoe S, Wagner A, Cortsen M. Endovascular embolization of intracranial iatrogenic pseudoaneurysms. A report of two cases and review of the literature. Neuroradiol J 2010; 23:479-83. [PMID: 24148643 DOI: 10.1177/197140091002300420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/27/2010] [Indexed: 11/17/2022] Open
Abstract
Iatrogenic pseudoaneurysm is a rare but severe complication of intracranial surgery. Treatment of the condition is difficult. The purpose of this report is to draw attention to the fact that endovascular embolization of pseudoaneurysms with parent artery preservation is possible. We describe two cases of endovascular embolization and review the literature. The conclusion is that endovascular treatment can be safe and curative.
Collapse
Affiliation(s)
- S Hjortoe
- Neuroradiology Department, Rigshospitalet; Copenhagen, Denmark -
| | | | | |
Collapse
|