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Baek JW, Kim ST, Lee YS, Jeong YG, Jeong HW, Baek JW, Seo JH. Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent. J Cerebrovasc Endovasc Neurosurg 2016; 18:306-314. [PMID: 27847780 PMCID: PMC5104861 DOI: 10.7461/jcen.2016.18.3.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 11/23/2022] Open
Abstract
We report the case of a recurrent carotid cavernous fistula (CCF) originating from a giant cerebral aneurysm (GCA) after placement of a covered stent. A 47-year-old woman presented with sudden onset of severe headache, and left-sided exophthalmos and ptosis. Cerebral angiography revealed a CCF caused by rupture of a GCA in the cavernous segment of the left internal carotid artery. Two covered stents were placed at the neck of the aneurysm. The neurological symptoms improved at first, but were aggravated in the 6 months following the treatment. Contrast agent endoleak was seen in the distal area of the stent. Even though additional treatments were attempted via an endovascular approach, the CCF could not be cured. However, after trapping the aneurysm using coils and performing superficial temporal artery-middle cerebral artery bypass, the neurological symptoms improved. In cases of recurrent CCF originating from a GCA after placement of a covered stent, it is possible to treat the CCF by endovascular trapping and surgical bypass.
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Affiliation(s)
- Jung Wook Baek
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Young Seo Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Young-Gyun Jeong
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Jin Wook Baek
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
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Gierthmuehlen M, Schumacher M, Zentner J, Hader C. Brainstem compression caused by bilateral traumatic carotid cavernous fistulas: case report. Neurosurgery 2011; 67:E1160-3; discussion E1163-4. [PMID: 20881535 DOI: 10.1227/neu.0b013e3181edb148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bilateral traumatic carotid cavernous fistulas (CCFs) are rare and may dilate the cavernous sinus. We present a case of brainstem compression caused by a cavernous sinus dilated by the arterial pressure of bilateral CCF. CLINICAL PRESENTATION A 30-year-old man suffered severe head trauma in a motorbike accident. Hemodynamically relevant, untreatable epistaxis required angiography, which revealed acute bleeding of the left sphenopalatine artery and bilateral traumatic CCFs. The bleeding was stopped by embolization with particles, and the left CCF was partially embolized to stabilize the patient hemodynamically. After short-term treatment and a long clinical course, the patient was referred to rehabilitation. Three months after trauma, the patient presented with severe headache and a dilated right pupil; he was somnolent. Immediate cerebral computed tomography scan showed a retroclival mass compressing the brainstem. Digital subtraction angiography revealed a reperfused left-sided CCF causing a huge dilatation of the retroclival cavernous sinus. After embolization with 2 balloons, the symptoms resolved and the patient was readmitted to rehabilitation. CONCLUSION Bilateral traumatic CCFs are uncommon. Brainstem impairment caused by venous congestion and consecutive edema is an extremely rare complication of CCFs, with only a few cases reported in the literature. Direct compression of the brainstem by CCFs has, to the best of our knowledge, never been reported before. Immediate endovascular intervention led to complete remission of the symptoms.
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Eddleman CS, Hurley MC, Bendok BR, Batjer HH. Cavernous carotid aneurysms: to treat or not to treat? Neurosurg Focus 2009; 26:E4. [DOI: 10.3171/2009.2.focus0920] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most cavernous carotid aneurysms (CCAs) are considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. However, several conditions may exist in which treatment of these aneurysms should be considered. Several options are currently available regarding the management of CCAs with resultant good outcomes, namely expectant management, luminal preservation strategies with or without addressing the aneurysm directly, and Hunterian strategies with or without revascularization procedures. In this article, we discuss the sometimes difficult decision regarding whether to treat CCAs. We consider the natural history of several types of CCAs, the clinical presentation, the current modalities of CCA management and their outcomes to aid in the management of this heterogeneous group of cerebral aneurysms.
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Affiliation(s)
| | - Michael C. Hurley
- 2Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bernard R. Bendok
- 1Departments of Neurological Surgery and
- 2Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Hedges TR, Quiros PA. Vascular Disorders. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Eddleman CS, Surdell D, Miller J, Shaibani A, Bendok BR. Endovascular management of a ruptured cavernous carotid artery aneurysm associated with a carotid cavernous fistula with an intracranial self-expanding microstent and hydrogel-coated coil embolization: case report and review of the literature. ACTA ACUST UNITED AC 2007; 68:562-7; discussion 567. [DOI: 10.1016/j.surneu.2006.10.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 10/30/2006] [Indexed: 10/22/2022]
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Díaz MB, Mercado FC, Lemme Plaghos LA. "Mirror-image" bilateral giants: intracavernous carotid artery aneurysms. Interv Neuroradiol 2006; 12:251-6. [PMID: 20569579 DOI: 10.1177/159101990601200308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 08/15/2006] [Indexed: 11/16/2022] Open
Abstract
SUMMARY The literature on the incidence of "mirror image" bilateral giant intracavernous aneurysms, their symptoms and their association with other entities is reviewed, with a brief comment on their evolution and treatment. A case of "mirror image" bilateral giant intracavernous aneurysms in a 76-year-old man who presented a sudden diplopia with pupillary sparing is reported. A CT scan showed parasellar images and dolichomega circle of Willis arteries that enhanced with endovenous contrast. MRI and angiography disclose bilateral aneurysms in detail, associated with an anomalous origin of the left common carotid artery and bilateral renal artery stenosis.
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Affiliation(s)
- M B Díaz
- Healt Sciences University, Barcelò Foundation, La Rioja, Argentina
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do Souto AA, Domingues FS, Espinosa G, Wajnberg E, Chagas H, Tragante R, Altino M, André C, de Souza JM. Complex paraclinoidal and giant cavernous aneurysms: importance of preoperative evaluation with temporary balloon occlusion test and SPECT. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:768-73. [PMID: 17057883 DOI: 10.1590/s0004-282x2006000500013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 07/01/2006] [Indexed: 11/22/2022]
Abstract
In the treatment of complex paraclinoidal and giant cavernous aneurysms, preservation of the patency of the internal carotid artery (ICA) is not always possible, and therapeutic occlusion of the carotid is still an important option for their management. A complete preoperative evaluation of the carotid reserve circulation, including the use of temporary balloon occlusion test and single photon emission computerized tomography (SPECT) should be included in the current paradigms of paraclinoidal and intracavernous aneurysms management. We present a series of fifteen patients with sixteen giant or complex carotid cavernous or ophthalmic aneurysms that were treated following a protocol for our preoperative decision-making analysis. Extracranial to intracranial saphenous vein bypass was reserved to the cases where carotid occlusion would be associated with high risk of ischemic complications and was performed in three patients. Besides the difficulties in dealing with those complex aneurysms, good clinical outcome was possible in our experience with the designed paradigm.
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Affiliation(s)
- Antônio Aversa do Souto
- Serviço de Neurocirurgia, Departamento de Cirurgia, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, UFRJ, 21941-590 Rio de Janeiro RJ, Brazil.
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Cakir E, Karaarslan G, Kuzeyli K, Usul H, Sayin OC, Birinci O, Baykal S. Intracavernous carotid artery aneurysms. J Clin Neurosci 2004; 11:859-62. [PMID: 15519863 DOI: 10.1016/j.jocn.2003.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Accepted: 11/14/2003] [Indexed: 10/26/2022]
Abstract
Six patients with intracavernous carotid artery aneurysms (ICCAAns) were seen at our department from 1998 to 2002. All patients had only one intracranial aneurysm and their ages at diagnosis ranged from 36 to 72 years (median 56). Five were women and four had a history of hypertension. One patient was pregnant. All of the ICCAAns were symptomatic at diagnosis. Duration of symptoms was 2-30 days. On admission to our department, initial symptom was headache in four patients, visual loss in two, eye pain in one, third nerve paresis in two and subarachnoid hemorrhage (SAH) in one. Spontaneous thrombosis was present in two patients. All of the ICCAAns were saccular. Computed tomography (CT) was superior when compared with magnetic resonance imaging (MRI) for diagnosis of ICCAAns on admission. Angiography remains the gold standard for diagnosis and determination of specific anatomical details, which are necessary to plan treatment.
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Affiliation(s)
- Ertugrul Cakir
- Department of Neurosurgery, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
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Zhang YJ, Dion JE, Barrow DL, Cawley CM. Endovascular Therapy for Cavernous Sinus Vascular Lesions. ACTA ACUST UNITED AC 2003. [DOI: 10.1097/00127927-200308040-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Fattahi TT, Brandt MT, Jenkins WS, Steinberg B. Traumatic carotid-cavernous fistula: pathophysiology and treatment. J Craniofac Surg 2003; 14:240-6. [PMID: 12621297 DOI: 10.1097/00001665-200303000-00020] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traumatic carotid-cavernous fistulae are rare yet potentially lethal vascular anomalies in the skull base seen after craniomaxillofacial trauma. This aberrant vascular communication has been extensively evaluated and classified, with a number of treatment modalities available to clinicians. The ultimate and definitive treatment of carotid-cavernous fistulae falls beyond the scope of craniomaxillofacial surgery. Nevertheless, clinicians treating patients with craniofacial injuries should have a complete understanding of this pathological entity, because urgent intervention may improve patient outcome.
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Affiliation(s)
- Tirbod T Fattahi
- Division of Maxillofacial Surgery, Department of Surgery, University of Florida-Jacksonville, 32209, USA.
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van der Schaaf IC, Brilstra EH, Buskens E, Rinkel GJE. Endovascular treatment of aneurysms in the cavernous sinus: a systematic review on balloon occlusion of the parent vessel and embolization with coils. Stroke 2002; 33:313-8. [PMID: 11779933 DOI: 10.1161/hs0102.101479] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Balloon occlusion of the parent vessel and endosaccular coiling are both frequently used for treatment of intracavernous aneurysms of the carotid artery. We performed a systematic review of studies reporting on these two treatment modalities to assess the rate of complications, rate of successful aneurysm occlusion, and clinical condition after treatment. METHODS We performed a MEDLINE search for studies published between January 1974 and May 1999 and hand-searched recent volumes of 21 journals. Two authors independently extracted data by means of a standardized data extraction form. RESULTS We found 35 studies reporting on 316 patients. Only 9 of the 35 studies reported on more than 5 patients; in only 9 studies (totaling 85 patients), well-defined outcome measures were used. Twenty-five studies (with 78% of all patients included in the review) reported on balloon occlusion. Complications during or in the first 24 hours after the balloon occlusion occurred in 4 of 247 patients (1.6%; 95% CI, 0.01% to 3.2%) and late ischemic complications in 5 of 148 patients (3.4%; 95% CI, 0.43% to 6.4%). Clinical follow-up was performed in 21 of 25 studies on treatment by means of balloon occlusion (148 [60%] of the 247 patients). None of the 68 patients treated by embolization with coils had a complication (0%; 95% CI, 0% to 4.3%). Of 157 aneurysms treated by balloon occlusion, 153 were completely thrombosed (97.5%; 95% CI, 95% to 100%). After coiling, 52 of 65 aneurysms (80%; 95% CI, 70% to 90%) were occluded by >90%. CONCLUSIONS Many studies included in this review had methodological weaknesses. The available data suggest that both balloon occlusion and endosaccular coiling are reasonably safe and result in occlusion of the aneurysm in the majority of patients. However, long-term outcomes have not yet been reported.
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van Rooij WJ, Sluzewski M, Metz NH, Nijssen PC, Wijnalda D, Rinkel GJ, Tulleken CA. Carotid balloon occlusion for large and giant aneurysms: evaluation of a new test occlusion protocol. Neurosurgery 2000; 47:116-21; discussion 122. [PMID: 10917354 DOI: 10.1097/00006123-200007000-00025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Validation of a new angiographic test occlusion protocol before carotid balloon occlusion in patients with carotid aneurysms. METHODS Carotid occlusion was considered for 29 consecutive patients. From 1993 to 1995, test occlusion in four patients consisted of clinical observation for 30 minutes and during electroencephalographic registration. From 1996 onward, test occlusion in 25 patients consisted of clinical observation and angiography of collateral vessels. Permanent balloon occlusion was performed only when the cortical veins in both the occluded and the collateral vascular territories filled synchronously. RESULTS Two of the four patients with normal clinical and electroencephalographic findings during test occlusion developed delayed hypoperfusion infarction after permanent carotid occlusion. Seventeen of 25 patients (68%) demonstrated both clinical and angiographic tolerance, and no ischemic events occurred after permanent carotid occlusion. In one patient with clinical tolerance but angiographic nontolerance, permanent carotid occlusion had to be performed, which resulted in delayed hypoperfusion infarction. In two patients with angiographic nontolerance, venous filling became synchronous after bypass surgery. Long-term clinical follow-up showed an alleviation of the symptoms of mass effect in 14 of 21 patients (67%). Magnetic resonance imaging follow-up (range, 3-70 mo) revealed a reduction in the size of the aneurysm in 19 of 21 patients (90%). CONCLUSION Test occlusion with clinical and angiographic control is reliable, safe, and simple to perform.
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Affiliation(s)
- W J van Rooij
- Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands.
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van Rooij WJJ, Sluzewski M, Metz NH, Nijssen PCG, Wijnalda D, Rinkel GJE, Tulleken CAF. Carotid Balloon Occlusion for Large and Giant Aneurysms: Evaluation of a New Test Occlusion Protocol. Neurosurgery 2000. [DOI: 10.1227/00006123-200007000-00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abruzzo T, Joseph GJ, Owens DS, Dawson RC, Reid J, Barrow DL. Prevention of Complications Resulting from Endovascular Carotid Sacrifice: A Retrospective Assessment. Neurosurgery 2000. [DOI: 10.1227/00006123-200004000-00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abruzzo T, Joseph GJ, Owens DS, Dawson RC, Reid J, Barrow DL. Prevention of complications resulting from endovascular carotid sacrifice: a retrospective assessment. Neurosurgery 2000; 46:910-6; discussion 916-7. [PMID: 10764264 DOI: 10.1097/00006123-200004000-00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine the protective effects of various periprocedural interventions in the prevention of cerebral ischemia as a complication of endovascular carotid sacrifice (ECS). METHODS Thirty-two cases of ECS performed at our institution, between October 1987 and July 1998, were reviewed. Fifteen patients underwent superficial temporal artery-to-middle cerebral artery bypass surgery. In 21 patients, the carotid artery was occluded proximal to the target lesion; and in 11 patients, a lesion trapping procedure was performed. Six patients were prophylactically anticoagulated, 14 received antiplatelet agents prophylactically, and 12 received no pharmacoprophylaxis. RESULTS Among the six patients who were anticoagulated, there were no embolic events. Embolic events affected 4 of 14 patients receiving prophylactic antiplatelet agents, 2 of 12 patients receiving no pharmacoprophylaxis, 1 of 11 patients who underwent a trapping procedure, and 5 of 21 patients whose carotid artery was occluded proximal to the target lesion. Postocclusion cerebral ischemia developed in 7 of 15 patients who underwent bypass surgery, and in 1 of the remaining 17. CONCLUSION Superficial temporal artery-to-middle cerebral artery bypass did not protect against postocclusion cerebral ischemia after ECS in this series (P = 0.01). Although the small number of patients studied precludes statistical validity (P = 0.29), the trends suggest that antiplatelet agents provide no protection against postocclusion cerebral emboli after ECS. Prophylactic anticoagulation (P = 0.32) and lesion trapping (P = 0.12) may reduce the frequency of postocclusion embolic events after ECS; however, because of the small number of patients, statistical significance could not be demonstrated.
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Affiliation(s)
- T Abruzzo
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Hemphill JC, Gress DR, Halbach VV. Endovascular therapy of traumatic injuries of the intracranial cerebral arteries. Crit Care Clin 1999; 15:811-29. [PMID: 10569123 DOI: 10.1016/s0749-0704(05)70089-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traumatic intracranial arterial injuries represent uncommon complications of both closed-head injury and penetrating head trauma. These injuries include arterial dissections, pseudoaneurysms, and fistulas, both direct and indirect. Although these lesions may be identified while still asymptomatic, they usually present in a delayed fashion with intracranial hemorrhage, focal cerebral ischemia, or, occasionally, severe epistaxis. Endovascular therapy has assumed a major role in the management of this diverse group of lesions. Embolization of pseudoaneurysms with balloons or detachable coils, the use of embolic particles for small arterial injuries, and large vessel occlusion with detachable balloons represent current treatment strategies that have evolved over the past three decades. Angioplasty and stent deployment may have a future role to play in the management of arterial dissection. Principles of neurologic critical care that minimize secondary brain injury are essential adjuncts in the management of these patients before, during, and after endovascular treatment.
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Affiliation(s)
- J C Hemphill
- Department of Neurology, University of California, San Francisco, USA
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Mericle RA, Wakhloo AK, Lopes DK, Lanzino G, Guterman LR, Hopkins LN. Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report. J Neurosurg 1998; 89:142-5. [PMID: 9647186 DOI: 10.3171/jns.1998.89.1.0142] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Guglielmi detachable coil (GDC) treatment for complicated cerebral aneurysms is an attractive option that has become widely accepted in recent years. This technique is usually considered only if the patient harbors an aneurysm that is not a good candidate for surgical clipping. However, the definition of "surgical candidate" varies among institutions, and many patients worldwide are being treated with GDCs as primary therapy. Although most centers currently perform follow-up angiography at 6 months to 1 year, others do not routinely perform it after an initially good result. The authors present a case that indicates longer follow up may be necessary and illustrates some of the pitfalls of GDC treatment. This 56-year-old man presented to the emergency room with a Hunt and Hess Grade II subarachnoid hemorrhage and was found to have a wide-necked basilar apex aneurysm. Because of associated medical comorbidities, it was decided to treat the aneurysm with endovascular techniques. The patient did well on follow-up angiography at 1 year postprocedure. However, at approximately 2 years follow up, the aneurysm was demonstrated to have dramatically recanalized and regrown, requiring open surgical intervention. Endovascular coiling was insufficient to treat this aneurysm and complicated definitive surgical management because a large coil mass had been placed in the operative field. It can be inferred from this case that angiographic follow up of these types of lesions may be beneficial up to 2 years after GDC treatment.
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Affiliation(s)
- R A Mericle
- Department of Neurosurgery and Toshiba Stroke Research Center, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, USA
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Affiliation(s)
- J V Byrne
- Department of Neuroradiology, Radcliffe Infirmary, Oxford, UK
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