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Pilipenko YV, Konovalov AN, Eliava SS, Bocharov AV, Okishev DN. [Successful combination treatment of giant bicameral fusiform partially thrombosed vertebral artery aneurysm at 12-year-old patient (practical case and literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:67-77. [PMID: 31825377 DOI: 10.17116/neiro20198305167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Giant cerebral aneurysms are diagnosed more often in children than in adults. Treatment of giant aneurysms is carried out both by endovascular and microsurgical methods. Literature information on combination of microsurgical and endovascular operations of cerebral aneurysms at children is little. A clinical case of the combined treatment of a giant bicameral fusiform partially thrombosed aneurysm of the right vertebral artery at a 12-year-old patient and a literature review on this topic are presented. The patient underwent several complex neurosurgical interventions during two operations: 1) microsurgery including revascularization of the right posterior lower cerebellar artery, thrombectomy and trapping of the larger chamber of fusiform aneurysm of the right vertebral artery, and 2) endovascular, which consists in the installation of redirecting stent from the left vertebral artery to main artery. The uniqueness of the case which we presented lies in the fact that the tactics of stage combined treatment for a complex aneurysm at child was originally planned and successfully implemented. The treatment allowed to ensure a complete shutdown of aneurysm and to exclude postoperative cerebral complications.
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Affiliation(s)
| | | | | | | | - D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
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2
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Sturiale CL, Stifano V, Della Pepa GM, Albanese A, Fernandez E, Marchese E, Puca A, Sabatino G, Olivi A. Intracranial aneurysms of the posterior circulation associated with a fenestration: a systematic review. J Neurosurg Sci 2019; 63:588-599. [DOI: 10.23736/s0390-5616.18.04225-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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3
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Phan K, Schultz K, Lu VM, Campbell RJ, Wang N, Rao PJ. Paediatric vertebral artery aneurysms: a literature review. ANZ J Surg 2017; 87:339-344. [PMID: 28320076 DOI: 10.1111/ans.13940] [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: 06/09/2016] [Revised: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 11/26/2022]
Abstract
Vertebral artery (VA) aneurysms in the paediatric population are a rare but a serious condition. However, the epidemiology of paediatric VA aneurysms is poorly understood and there is little consensus on what constitutes the appropriate treatment. Although multiple treatment options are available, including surgery, endovascular approaches, coil embolization and parent artery occlusion, there is limited clinical evidence regarding which approach is most optimal. This review outlines the current literature and evidence outlining the epidemiology, presentation, pathogenesis and treatment of paediatric VA aneurysms.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Konrad Schultz
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Victor M Lu
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Ryan J Campbell
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Nelson Wang
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Prashanth J Rao
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
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4
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Graziano F, Ganau M, Iacopino DG, Boccardi E. Vertebro-basilar junction aneurysms: a single centre experience and meta-analysis of endovascular treatments. Neuroradiol J 2014; 27:732-41. [PMID: 25489898 DOI: 10.15274/nrj-2014-10100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/23/2014] [Indexed: 11/12/2022] Open
Abstract
Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option.
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Affiliation(s)
- Francesca Graziano
- Neurosurgical Clinic, "P. Giaccone" University Hospital, Palermo University Palermo; Palermo, Italy -
| | - Mario Ganau
- Graduate School of Biomedical Engineering, University of Cagliari; Cagliari, Italy
| | | | - Edoardo Boccardi
- Department of Neuroradiology, Niguarda Ca' Grande Institution; Milan, Italy
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Serrone JC, Gozal YM, Grossman AW, Andaluz N, Abruzzo T, Zuccarello M, Ringer A. Vertebrobasilar Fusiform Aneurysms. Neurosurg Clin N Am 2014; 25:471-84. [DOI: 10.1016/j.nec.2014.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Park HS, Nakagawa I, Wada T, Nakagawa H, Hironaka Y, Kichikawa K, Nakase H. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization. Surg Neurol Int 2014; 5:S143-7. [PMID: 25071937 PMCID: PMC4109167 DOI: 10.4103/2152-7806.134807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/25/2014] [Indexed: 11/04/2022] Open
Abstract
Background: Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. Case Description: A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Conclusion: Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option.
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Affiliation(s)
- Hun-Soo Park
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Takeshi Wada
- Department of Radiology, Nara Medical University, Nara, Japan
| | | | - Yasuo Hironaka
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Cooke DL, Stout CE, Kim WT, Kansagra AP, Yu JP, Gu A, Jewell NP, Hetts SW, Higashida RT, Dowd CF, Halbach VV. Cerebral arterial fenestrations. Interv Neuroradiol 2014; 20:261-74. [PMID: 24976087 DOI: 10.15274/inr-2014-10027] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 01/01/2014] [Indexed: 01/07/2023] Open
Abstract
Arterial fenestrations are an anatomic variant with indeterminate significance. Given the controversy surrounding fenestrations we sought their prevalence within our practice along with their association with other cerebrovascular anomalies. We retrospectively reviewed 10,927 patients undergoing digital subtraction angiography between 1992 and 2011. Dictated reports were searched for the terms "fenestration" or "fenestrated" with images reviewed for relevance, yielding 228 unique cases. A Medline database search from February 1964 to January 2013 generated 304 citations, 127 cases of which were selected for analysis. Cerebral arterial fenestrations were identified in 228 patients (2.1%). At least one aneurysm was noted in 60.5% of patients, with an aneurysm arising from the fenestration in 19.6% of patients. Aneurysmal subarachnoid hemorrhage or non-aneurysmal subarachnoid hemorrhage were present in 60.1% and 15.8%, respectively. For the subset of patients with an aneurysm arising directly from a fenestration relative to those patients with an aneurysm not immediately associated with a fenestration, the prevalence of aneurysmal subarachnoid hemorrhage was 66.7% vs. 58.6% (p = 0.58). Fenestrations were more often within the posterior circulation (73.2%) than the anterior circulation (24.6%), though there was no difference in the prevalence of aneurysms within these groups (61.1% vs. 60.7%, p = 1.0). Cerebral arterial fenestrations are an anatomic variant more often manifesting at the anterior communicating arterial complex and basilar artery and with no definite pathological relationship with aneurysms.
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Affiliation(s)
- Daniel L Cooke
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA -
| | - Charles E Stout
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Warren T Kim
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Akash P Kansagra
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - John Paul Yu
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Amy Gu
- University of California; Berkeley, CA, USA
| | | | - Steven W Hetts
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Randall T Higashida
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Christopher F Dowd
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Van V Halbach
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
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Vulev I, Klepanec A, Bazik R, Balazs T, Illes R, Steno J. Endovascular treatment of internal carotid and vertebral artery aneurysms using a novel pericardium covered stent. Interv Neuroradiol 2012; 18:164-71. [PMID: 22681731 DOI: 10.1177/159101991201800207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 01/22/2012] [Indexed: 10/20/2022] Open
Abstract
Intracranial aneurysm is a fairly common (often asymptomatic) condition. Subarachnoid hemorrhage associated with aneurysmal rupture is a potentially lethal event with a mortality rate as high as 50 percent and a high rate of disability among those who survive the initial hemorrhage, such that recently published guidelines support treatment of intracerebral aneurysms. The current treatment options include surgical clipping and endovascular treatment, but these are not without significant problems. Despite the trend toward endovascular treatment the rate of recurrence and complications is high. Current published evidence of the use of covered stent is limited to stents covered with polytetrafluoroethylene. It is now recognized that mammalian extracellular matrix represents an excellent scaffold material suitable for many therapeutic applications and glutaraldehyde treated pericardium has been widely used for many years due to its desirable features such as low immunogenicity and durability. This report describes the first published experience with the Aneugraft Pericardium Covered Stent (ITGI Medical, OR Akiva, Israel) in the treatment of internal carotid and vertebral artery aneurysms in three patients. In all three cases, the implantation of this novel device has resulted in successful closure of aneurysms.
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Affiliation(s)
- I Vulev
- Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
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Principles in Case-Based Aneurysm Treatment: Approaching Complex Lesions Excluded by International Subarachnoid Aneurysm Trial (ISAT) Criteria. World Neurosurg 2011; 75:462-75. [DOI: 10.1016/j.wneu.2010.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 09/26/2010] [Accepted: 10/04/2010] [Indexed: 11/18/2022]
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Clarençon F, Bonneville F, Boch AL, Lejean L, Biondi A. Parent artery occlusion is not obsolete in giant aneurysms of the ICA. Experience with very-long-term follow-up. Neuroradiology 2010; 53:973-82. [PMID: 21152912 DOI: 10.1007/s00234-010-0800-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/03/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris VI University, 47 Bd de l'Hôpital, 75013, Paris, France.
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Martin AJ, Hetts SW, Dillon WP, Higashida RT, Halbach V, Dowd CF, Lawton MT, Saloner D. MR imaging of partially thrombosed cerebral aneurysms: characteristics and evolution. AJNR Am J Neuroradiol 2010; 32:346-51. [PMID: 21087941 DOI: 10.3174/ajnr.a2298] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A comprehensive evaluation of aneurysmal morphometry requires appreciation of both the vascular lumen and the intraluminal thrombus. MR imaging methods can both evaluate the lumen and directly image the vessel wall. We investigated the ability of T1-weighted, T2-weighted, and steady-state MR imaging techniques to delineate thrombus morphology and reveal changes with time. MATERIALS AND METHODS Nine patients with fusiform basilar or intracranial vertebral artery aneurysms that contained intraluminal thrombus were studied with MR imaging. All patients underwent at least 2 imaging sessions, which were separated by 4-22 months. Analysis of signal intensity to determine the mean signal intensity from thrombus, blood, CSF, and brain in matched regions was performed. Aneurysm maximal diameter and cross-sectional area were determined with and without thrombus. RESULTS Thrombus was identified on all image sequences, and its general appearance was consistent between imaging sessions. Thrombus produced the highest and most consistent signal intensities with T1-weighted and steady-state techniques, though the latter showed superior contrast between luminal blood and thrombus. Heterogeneity within clot was evident in 4/9 of patients, with peripheral hyperintensity being a common feature. CONCLUSIONS Steady-state imaging was found to be superior to T1- and T2-weighted imaging for delineating and characterizing intraluminal thrombus within aneurysms. The imaging characteristics of intraluminal thrombus proved to be very consistent for long periods. Assessment of overall aneurysm size, including thrombosed portions, permits more accurate evaluation of aneurysm growth and concomitantly may permit more informed clinical decision-making with regard to the timing and need for aneurysm treatment.
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Affiliation(s)
- A J Martin
- Department of Radiology, University of California, San Francisco, 94143, USA.
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Wilms G, Buyse G, van Loon J, Maleux G. Treatment of a giant basilar artery aneurysm with a bridging stent and subsequent coil occlusion of the stent: case report. Neurosurgery 2010; 67:E510-1. [PMID: 20644381 DOI: 10.1227/01.neu.0000372225.37968.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE To report the treatment of a symptomatic giant basilar artery aneurysm in a child. CLINICAL PRESENTATION A 7-year-old girl presented with a 2-month history of progressive right hemiparesis caused by a huge fusiform aneurysm of the basilar artery with compression of the brainstem. INTERVENTION OR TECHNIQUE: The patient was treated with a bridging bare stent and occlusion of the stent lumen with detachable coils. CONCLUSION The patient experienced immediate total occlusion of the aneurysm with almost total recuperation after 1 year.
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Affiliation(s)
- Guido Wilms
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
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Ten-year follow-up of giant basilar aneurysm treated by sole stenting technique: a case report. J Med Case Rep 2010; 4:64. [PMID: 20175900 PMCID: PMC2843709 DOI: 10.1186/1752-1947-4-64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 02/22/2010] [Indexed: 11/17/2022] Open
Abstract
Introduction The sole stenting technique has emerged as a new tool for the management of intracranial aneurysms. However, several concerns have emerged about the long-term behavior of intracranial stents, particularly their safety and efficacy. Case presentation We present the first case of an intracranial aneurysm intentionally treated with the sole stenting technique. After ten years of clinical and imaging follow-up, the lesion has healed and no intrastent stenosis is observed. Several issues concerning this technique are discussed. For instance, the modification of the angle and intra-aneurysmal thrombosis may account as positive effects; negative outcomes include in-stent thrombosis or stenosis. Conclusions This case report, involving a long clinical and imaging follow-up, provides an example of the effectiveness, safety, durability and simplicity of the sole stenting technique in the management of intracranial aneurysms.
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