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Griauzde J, Ravindra VM, Chaudhary N, Gemmete JJ, Mazur MD, Roark CD, Couldwell WT, Park MS, Taussky P, Pandey AS. Use of the Pipeline embolization device in the treatment of iatrogenic intracranial vascular injuries: a bi-institutional experience. Neurosurg Focus 2018; 42:E9. [PMID: 28565993 DOI: 10.3171/2017.3.focus1735] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Flow-diverting devices have been used for the treatment of complex intracranial vascular pathology with success, but the role of these devices in treating iatrogenic intracranial vascular injuries has yet to be clearly defined. Here, the authors report their bi-institutional experience with the use of the Pipeline embolization device (PED) for the treatment of iatrogenic intracranial vascular injuries. METHODS The authors reviewed a retrospective cohort of patients with iatrogenic injuries to the intracranial vasculature that were treated with the PED between 2012 and 2016. Data collection included demographic data, indications for treatment, number and sizes of PEDs used, and immediate and follow-up angiographic and clinical outcomes. RESULTS Four patients with a mean age of 47.5 years (range 18-63 years) underwent PED placement for iatrogenic vessel injuries. In 3 patients, the intracranial internal carotid artery (ICA) was injured during transnasal tumor resection. In 1 patient, a basilar apex injury occurred during endoscopic third ventriculostomy. Three patients had a pseudoaneurysm as a result of vessel injury, and 1 patient had frank ICA laceration and extravasation. All 3 pseudoaneurysms were successfully treated with PED deployment. The ICA laceration was refractory to PED placement, and the vessel was subsequently occluded endovascularly. All 4 patients had a good clinical outcome (modified Rankin Scale score of 0 or 1). CONCLUSIONS The use of the PED is feasible in the management of iatrogenic pseudoaneurysms of the intracranial vasculature. In cases of frank vessel perforation, an alternative strategy such as covered stent placement should be considered. Endovascular or surgical vessel occlusion remains the definitive treatment in cases of refractory hemorrhage.
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Affiliation(s)
| | - Vijay M Ravindra
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
| | | | - Joseph J Gemmete
- Departments of 1 Radiology.,Neurosurgery, and.,Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan
| | - Marcus D Mazur
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Christopher D Roark
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - William T Couldwell
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Min S Park
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
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Beez T, Steiger HJ, Hänggi D. Evolution of Management of Intracranial Aneurysms in Children: A Systematic Review of the Modern Literature. J Child Neurol 2016; 31:773-83. [PMID: 26516106 DOI: 10.1177/0883073815609153] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022]
Abstract
Pediatric intracranial aneurysms are rare. Management of their more common adult counterparts was profoundly influenced by recent high-quality clinical studies. The aim of this review was to aggregate the modern pediatric data published in the wake of these studies and to analyze their impact on management of aneurysms in children. A systematic PubMed search identified 135 publications published between 2000 and 2015, accounting for 573 children and 656 aneurysms. Descriptive statistical analyses revealed differences between children and adults concerning demographics and aneurysm characteristics. A significant proportion of patients were treated endovascularly, suggesting endovascular treatment has been established in the therapeutic armamentarium for pediatric aneurysms. However, these data highlight the unique nature of pediatric aneurysms, and neither this review nor generalization from adult data can replace high-quality clinical research. Multicenter registries and controlled trials are required to establish the natural history and evidence-based treatment of pediatric aneurysms.
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Affiliation(s)
- Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Universitätsmedizin Mannheim, Mannheim, Germany
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Chang SH, Lee SH, Shin HS, Koh JS. Spontaneous Occluded Anterior Communicating Artery Aneurysm during Coil Embolization Treated with One Coil Insertion into Remaining Stump. J Cerebrovasc Endovasc Neurosurg 2015; 17:246-51. [PMID: 26523260 PMCID: PMC4626350 DOI: 10.7461/jcen.2015.17.3.246] [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: 06/23/2015] [Revised: 08/14/2015] [Accepted: 09/02/2015] [Indexed: 11/23/2022] Open
Abstract
Spontaneous thrombosis of a ruptured aneurysm during coil embolization is a rare event, and some reports on recanalization of a spontaneous occluded ruptured aneurysm have been published. We report on a case of a 54-year-old male who presented with a subarachnoid hemorrhage due to rupture of a small aneurysm of the anterior communicating artery (ACoA). Cerebral angiography confirmed the presence of the ACoA aneurysm, but, during coil embolization, the aneurysm was near completely occluded with a remaining small neck. A small coil was inserted into the remaining stump of the neck to prevent recanalization, and the angiographic result at 1 year after coil embolization showed complete obliteration of the aneurysm.
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Affiliation(s)
- Se Hun Chang
- Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Hwan Lee
- Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Sup Shin
- Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jun Seok Koh
- Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Munich SA, Cress MC, Rangel-Castilla L, Krishna C, Siddiqui AH, Snyder KV. Importance of repeat angiography in the diagnosis of iatrogenic anterior cerebral artery territory pseudoaneurysm following endoscopic sinus surgery. J Neurointerv Surg 2015; 8:e20. [PMID: 25994943 DOI: 10.1136/neurintsurg-2015-011693.rep] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/04/2022]
Abstract
Iatrogenic intracranial pseudoaneurysm formation and rupture are rare complications following endoscopic sinus surgery. Given the propensity for devastating neurologic injury after a relatively routine procedure, swift diagnosis and treatment is essential. The authors present a patient who experienced bifrontal intracranial hemorrhage and subarachnoid hemorrhage due to a ruptured iatrogenic frontopolar artery pseudoaneurysm caused during routine endoscopic sinus surgery. The pseudoaneurysm was not present on initial angiograms but became apparent radiographically 19 days after the endoscopic procedure. Endovascular treatment consisted of coil and Onyx embolization for sacrifice of the parent vessel proximal to the lesion. Early recognition of iatrogenic intracranial vascular injury is important to allow for rapid treatment. Initial radiographic studies may be unreliable in excluding the presence of a pseudoaneurysm so delayed repeat angiographic assessment is necessary, particularly in the presence of a high index of clinical suspicion. Endovascular techniques may provide an effective and safe option for the treatment of iatrogenic anterior cerebral artery distribution pseudoaneurysms.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | - Marshall C Cress
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | - Chandan Krishna
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | | | - Kenneth V Snyder
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA
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Munich SA, Cress MC, Rangel-Castilla L, Krishna C, Siddiqui AH, Snyder KV. Importance of repeat angiography in the diagnosis of iatrogenic anterior cerebral artery territory pseudoaneurysm following endoscopic sinus surgery. BMJ Case Rep 2015; 2015:bcr-2015-011693. [PMID: 25979961 DOI: 10.1136/bcr-2015-011693] [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
Iatrogenic intracranial pseudoaneurysm formation and rupture are rare complications following endoscopic sinus surgery. Given the propensity for devastating neurologic injury after a relatively routine procedure, swift diagnosis and treatment is essential. The authors present a patient who experienced bifrontal intracranial hemorrhage and subarachnoid hemorrhage due to a ruptured iatrogenic frontopolar artery pseudoaneurysm caused during routine endoscopic sinus surgery. The pseudoaneurysm was not present on initial angiograms but became apparent radiographically 19 days after the endoscopic procedure. Endovascular treatment consisted of coil and Onyx embolization for sacrifice of the parent vessel proximal to the lesion. Early recognition of iatrogenic intracranial vascular injury is important to allow for rapid treatment. Initial radiographic studies may be unreliable in excluding the presence of a pseudoaneurysm so delayed repeat angiographic assessment is necessary, particularly in the presence of a high index of clinical suspicion. Endovascular techniques may provide an effective and safe option for the treatment of iatrogenic anterior cerebral artery distribution pseudoaneurysms.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | - Marshall C Cress
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | - Chandan Krishna
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY, USA
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Ringelstein A, Mueller O, Timochenko O, Moenninghoff C, Sure U, Forsting M, Schlamann M. Reangiographie nach perimesenzephaler Subarachnoidalblutung. DER NERVENARZT 2013; 84:715-9. [DOI: 10.1007/s00115-013-3803-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Two cases of ruptured cerebral aneurysms presenting with contralateral hematomas. Emerg Radiol 2011; 18:39-42. [DOI: 10.1007/s10140-010-0900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 08/14/2010] [Indexed: 10/19/2022]
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Choi YS, Kim DW, Jang SJ, Kang SD. Recanalization of completely thrombosed non-giant saccular aneurysm mimicking as de novo aneurysm. J Korean Neurosurg Soc 2010; 48:354-6. [PMID: 21113364 DOI: 10.3340/jkns.2010.48.4.354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/09/2010] [Accepted: 09/27/2010] [Indexed: 11/27/2022] Open
Abstract
Partial thrombosis of giant aneurysms is not uncommon however, complete angiographic occlusion occurs less frequently. In the case of non-giant aneurysms, complete thrombosis and recanalization has been rarely reported. A 31-year-old man presented to the emergency department with sudden bursting headache. Brain computed tomography (CT) revealed diffuse subarachnoid hemorrhage on the left side. Both CT angiography (CTA) and digital subtraction angiography showed suspicion of small left anterior choroidal artery aneurysm. We performed surgical exploration. In the operation field, anterior choroidal artery aneurysm of 2 × 2 mm with broad neck and friable appearance was observed. Because we could not clip without sacrificing the anterior choroidal artery, we performed wrapping only. Follow up CTA after 7 months demonstrated 4 mm right internal carotid artery bifurcation aneurysm. The patient underwent aneurismal neck clipping. During the operation, 9 × 13 mm sized thrombosed aneurysm was detected and completely clipped. We initially thought this aneurysm to be a de novo aneurysm however, it was an aneurysm that had recanalized from a completely thrombosed aneurysm. This case report provides an insight into the potential for complete thrombosis and recanalization of non-giant aneurysms.
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Affiliation(s)
- Yong-Su Choi
- Department of Neurosurgery, College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
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