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Wang AJ, Vranic JE, Regenhardt RW, Dmytriw AA, Lee CK, Sadegh C, Rabinov JD, Stapleton CJ. Symptomatic perianeursymal cyst development 20 years after endovascular treatment of a ruptured giant aneurysm: Case report and updated review. J Cerebrovasc Endovasc Neurosurg 2024; 26:187-195. [PMID: 38148522 PMCID: PMC11220292 DOI: 10.7461/jcen.2023.e2023.02.001] [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: 01/30/2023] [Revised: 05/09/2023] [Accepted: 08/31/2023] [Indexed: 12/28/2023] Open
Abstract
Perianeurysmal cysts are a rare and poorly understood finding in patients both with treated and untreated aneurysms. While the prior literature suggests that a minority of perianeurysmal cysts develop 1-4 years following endovascular aneurysm treatment, this updated review demonstrates that nearly half of perianeurysmal cysts were diagnosed following aneurysm coiling, with the other half diagnosed concurrently with an associated aneurysm prior to treatment. 64% of perianeurysmal cysts were surgically decompressed, with a 39% rate of recurrence requiring re-operation. We report a case of a 71-year-old woman who presented with vertigo and nausea and was found to have a 3.4 cm perianeurysmal cyst 20 years after initial endovascular coiling of a ruptured giant ophthalmic aneurysm. The cyst was treated with endoscopic fenestration followed by open fenestration upon recurrence. The case represents the longest latency from initial aneurysm treatment to cyst diagnosis reported in the literature and indicates that the diagnosis of perianeurysmal cyst should remain on the differential even decades after treatment. Based on a case discussion and updated literature review, this report highlights proposed etiologies of development and management strategies for a challenging lesion.
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Affiliation(s)
- Amy J. Wang
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin E. Vranic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W. Regenhardt
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam A. Dmytriw
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine K. Lee
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cameron Sadegh
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James D. Rabinov
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J. Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Zammit A, Tudose A, Khan N, Renowden S, Teo M. Perianeurysmal parenchymal cysts – Case series and literature review. BRAIN AND SPINE 2022; 2:100920. [PMID: 36248106 PMCID: PMC9560574 DOI: 10.1016/j.bas.2022.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
Abstract
Intracranial cysts are associated with a number of vascular lesions. They predominantly occur in larger, partially-thrombosed aneurysms and in older patients. There is a trend towards enlargement over time if untreated and a likelihood of recurrence following treatment. We hypothesise the cysts arise either from dilated Virchow-Robin spaces and/or inflammatory processes.
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Commentary: Delayed Intracranial Parenchymal Changes After Aneurysmal Coil Embolization Procedures for Unruptured Intracranial Aneurysms. Oper Neurosurg (Hagerstown) 2020; 19:E39-E40. [DOI: 10.1093/ons/opz357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 11/12/2022] Open
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Headache and MRI Changes after Endovascular Treatment of a Cerebral Aneurysm. Case Rep Radiol 2020; 2019:6917902. [PMID: 31929934 PMCID: PMC6939425 DOI: 10.1155/2019/6917902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background The main complications after endovascular therapy of intracranial aneurysms are aneurysm rupture and thromboembolic events. Yet, the widespread use of magnetic resonance imaging (MRI) in follow-up of these patients also demonstrates other, rarely known complications such as aseptic meningitis and foreign body reaction. Case Presentation A small aneurysm in the right posterior communicating artery was treated with endovascular therapy in a 65 year old woman. Two weeks after successful interventional treatment, the patient developed a headache. On MRI performed five months after intervention, vasogenic edema was seen in the vascular territory of the right internal carotid artery. The edema and the symptoms diminished without specific treatment within a year. Interpretation The clinical and radiological presentation of this case are suggestive of a foreign body reaction, a treatable condition that radiologists and clinicians should be aware of.
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Verbraeken B, Achahbar SE, Kamerling N, Yperzeele L, Voormolen M, Van Havenbergh T, Menovsky T. Complete Transection of Optic Nerve After Endovascular Coiling of a Large Ophthalmic Artery Aneurysm. World Neurosurg 2019; 132:81-86. [DOI: 10.1016/j.wneu.2019.08.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
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Khalid Z, Sorteberg W, Nedregaard B, Sorteberg A. Efficiency and complications of Woven EndoBridge (WEB) devices for treatment of larger, complex intracranial aneurysms-a single-center experience. Acta Neurochir (Wien) 2019; 161:393-401. [PMID: 30547246 DOI: 10.1007/s00701-018-3752-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several recently published multicenter studies have reported high treatment feasibility, high safety, and good 6-month to 1-year efficiency when treating smaller intracranial aneurysms (IA) with WEB deployment. The purpose of the study was to evaluate the long-term efficiency and complications related to WEB treatment of larger, complex intracranial aneurysms in a small single-center cohort. METHODS Patients with ruptured and unruptured IA were treated with WEB devices; data were collected prospectively and analyzed retrospectively. The study evaluates complications and clinical and radiological findings at immediate and last available follow-up. RESULTS The study included 16 patients with 16 aneurysms and a median follow-up time of 36 months, range 13-49 months; 9/16 were females. Median age 59 with range 39-71 years. Mean aneurysm size 11.3 ± 1.7 mm, predominant location at the basilar artery bifurcation and anterior communicating artery. Three out of sixteen IAs were ruptured. Even though 75% of the IAs were immediately occluded completely, retreatment was eventually necessary in 7/15 (46.7%). Increasing neck remnants and recurrences were mainly observed past 1-year follow-up. The WEB device showed modifications over time, with six devices showing signs of compression in the long term. There was one fatality due to aneurysm rupture after 4 years. CONCLUSIONS The long-term efficiency of WEB deployment in larger, complex aneurysms is low with about half of the cases needing at least one retreatment. A large fraction of WEB collapse past 1-year follow-up.
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Affiliation(s)
- Zaid Khalid
- Institute of Clinical Medicine, University in Oslo, Problemveien 17, 0315, Oslo, Norway.
| | - Wilhelm Sorteberg
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bård Nedregaard
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Angelika Sorteberg
- Institute of Clinical Medicine, University in Oslo, Problemveien 17, 0315, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Lorentzen AO, Nome T, Bakke SJ, Scheie D, Stenset V, Aamodt AH. Cerebral foreign body reaction after carotid aneurysm stenting. Interv Neuroradiol 2015; 22:53-7. [PMID: 26510943 DOI: 10.1177/1591019915609171] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization--a multifocal inflammation spread out through the white matter of one hemisphere without hemorrhage or ischemic changes.
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Affiliation(s)
- Anastasia Orlova Lorentzen
- Department of Radiology, Østfold Hospital Trust HF, Norway Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
| | - Terje Nome
- Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway
| | - Søren Jacob Bakke
- Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Vidar Stenset
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
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Norris SA, Derdeyn CP, Perlmutter JS. Levodopa-responsive hemiparkinsonism secondary to cystic expansion from a coiled cerebral aneurysm. J Neuroimaging 2014; 25:316-318. [PMID: 24707971 DOI: 10.1111/jon.12117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/22/2014] [Accepted: 03/02/2014] [Indexed: 11/26/2022] Open
Abstract
An 80-year-old woman with longstanding hemifacial spasm had a 1 cm × 1.5 cm internal carotid artery terminus aneurysm treated with endovascularly delivered bare metal coils. Follow-up imaging revealed an expansile perianeurysmal cyst that coincided with development of contralateral dopa-responsive hemiparkinsonism. This is the first report of perianeurysmal cyst expansion causing levodopa-responsive hemiparkinsonism.
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Affiliation(s)
- Scott A Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Colin P Derdeyn
- Department of Neurology, Washington University School of Medicine, St. Louis, MO.,Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.,Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO.,Department of Radiology, Washington University School of Medicine, St. Louis, MO.,Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO.,Programs in Occupational Therapy, Washington University School of Medicine, St. Louis, MO.,Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO
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