1
|
Yamada K, Morimoto T, Fujimoto K, Nishioka T, Tokunaga H. Traumatic intracranial aneurysm in a distal posterior cerebral artery: A case report and literature review. Surg Neurol Int 2023; 14:428. [PMID: 38213445 PMCID: PMC10783693 DOI: 10.25259/sni_752_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/18/2023] [Indexed: 01/13/2024] Open
Abstract
Background Traumatic intracranial aneurysms (TICAs) are rare and known to rupture easily and have a high mortality rate. Case Description An 87-year-old male patient with no neurological deficits presented to our hospital after head trauma. Computed tomography (CT) revealed a tentorial acute subdural hematoma (ASDH). The patient was managed conservatively and discharged home six days after hospitalization. Two days later, the patient returned with a severe headache. CT showed that the ASDH had enlarged and extended from the tentorium to the convexity. CT angiography and digital subtraction angiography revealed a pseudoaneurysm in a branch of the left posterior inferior temporal artery. The patient was diagnosed with an enlarged ASDH due to a ruptured TICA that arose from the P3 segment. We performed endovascular intervention with parent artery occlusion (PAO) using n-butyl-2-cyanoacrylate (NBCA). The parent artery was accessed through the left posterior communicating artery because left vertebral angiography revealed an aplastic left P1 segment. After navigating the microcatheter near the aneurysm, we injected 33% NBCA into the parent artery. The pseudoaneurysm disappeared after injection. The patient was discharged on hospital day 25 despite persistent delirium. Conclusion This is the first report of a TICA arising from the P3 segment that was treated with PAO using NBCA. TICAs are rare; however, a TICA must be considered when an enlarged hematoma caused by head injury is detected.
Collapse
Affiliation(s)
- Kengo Yamada
- Department of Neurosurgery, Nara City Hospital, , Nara, Japan
| | | | - Kenta Fujimoto
- Department of Neurosurgery, Nara Prefecture General Medical Center, Nara, Japan
| | | | | |
Collapse
|
2
|
Tuan NHN, Van Khoa L, Van Tien Bao N, Tu PD, Van Phuoc L. Endovascular management of giant post-traumatic pseudoaneurysm in cavernous sinus: A case report. Radiol Case Rep 2023; 18:2514-2518. [PMID: 37214327 PMCID: PMC10199404 DOI: 10.1016/j.radcr.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
A 20-year-old male was admitted with the history of a traumatic head injury after traffic accident. The physical examination revealed blurred vision, swelling of the right face, and minor epistaxis. CT and MRI findings revealed a giant pseudoaneurysm of cavernous carotid artery. The patient was enrolled endovascular coils embolization of the internal carotid artery. After the procedure, the patient recovered well. Endovascular treatment is an effective therapy in cavernous carotid pseudoaneurysm.
Collapse
|
3
|
Sakaguchi M, Yamaguchi K, Funatsu T, Akihiro N, Moteki Y, Eguchi S, Ishikawa T, Kawamata T. Bilateral symptomatic large cavernous carotid artery aneurysms treated by extracranial-intracranial bypass with parent artery occlusion. Clin Neurol Neurosurg 2023; 229:107758. [PMID: 37163929 DOI: 10.1016/j.clineuro.2023.107758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
Bilateral large cavernous sinus internal carotid aneurysms (CCAs) occur very rarely. While the choice of treatment method is important, the timing of contralateral side treatment is equally important. We herein report the case of a 72-year-old woman who presented with progressive bilateral visual impairment and was treated by two-stage. First, the left CCAs had been treated, and the aneurysm was thrombosed, but her left visual acuity did not recover; the right CCA was becoming larger 2 years later, and her right visual acuity began worsening. The right CCAs was treated by almost same method. Her right visual acuity improved compared with the second preoperative findings. Our case findings suggest the importance of considering the appropriate timing to avoid symptom aggravation in patients with bilateral CCAs.
Collapse
Affiliation(s)
- Makiko Sakaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Takayuki Funatsu
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Niwa Akihiro
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Moteki
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Seiichiro Eguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
4
|
Lee HJ, Cho WC, Choi JH, Kim BS, Shin YS. Comparison of Parent Artery Occlusion and Stent-Assisted Treatments in Ruptured Vertebral Artery Dissecting Aneurysms. World Neurosurg 2022; 167:e533-e540. [PMID: 35977685 DOI: 10.1016/j.wneu.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications. METHODS This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications. RESULTS Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.01-1.56, P = 0.044) and poor Hunt-Hess grade (OR = 537.99, 95% CI = 6.73-42994.1, P = 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR = 15.97, 95% CI = 1.52-167.38, P = 0.021) and PICA involvement (OR = 13.71, 95% CI = 1.29-145.89, P = 0.030) were independent risk factors for ischemic complications. CONCLUSIONS Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.
Collapse
Affiliation(s)
- Hyeong Jin Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Woo Cheul Cho
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea.
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
| |
Collapse
|
5
|
Akimoto T, Ito Y, Akutagawa K, Sato M, Hayakawa M, Marushima A, Takigawa T, Tsuruta W, Kato N, Suzuki K, Uemura K, Yamamoto T, Matsumaru Y. Perioperative and long-term complications following therapeutic internal carotid artery occlusion. Interv Neuroradiol 2022:15910199221095786. [PMID: 35450482 PMCID: PMC10399501 DOI: 10.1177/15910199221095786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Parent artery occlusion (PAO) is an effective treatment for hemorrhagic diseases associated with the internal carotid artery. There are several reports of long-term cerebral infarction or the formation of de novo cerebral aneurysms following PAO. MATERIALS AND METHODS We retrospectively reviewed these complications in 38 patients who underwent PAO for therapeutic treatment. We investigated perioperative cerebral infarctions, long-term cerebral infarctions, and de novo aneurysms. RESULTS The mean age of the patients was 64.0 years, and 25 patients (65.8%) were female. The causative diseases were unruptured (n = 19; 50.0%) and ruptured (n = 8; 21.1%) aneurysms. PAO was performed after ischemic tolerance was assessed with balloon test occlusion (BTO), and BTO was performed in 34 patients, of whom 25 (73.5%) had ischemic tolerance. Twenty-six patients (68.4%) were treated with PAO alone, eight (23.5%) with low-flow bypass, and six (17.6%) with high-flow bypass. Perioperative complications occurred in five patients (13.2%): two of the 26 patients (7.7%) who underwent scheduled treatment and three of the 12 patients (25.0%) who underwent emergency treatment. One patient (2.6%) had long-term de novo aneurysm, and none developed cerebral infarction. CONCLUSIONS These results showed that the assessment of ischemic tolerance by performing BTO and appropriate revascularization in scheduled treatments are important to reduce perioperative and long-term cerebral infarctions. PAO must be performed with greater caution in emergency treatment.
Collapse
Affiliation(s)
- Taisuke Akimoto
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan.,Department of Neurosurgery, 26437Yokomhama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Kazuki Akutagawa
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, 26263Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Wataro Tsuruta
- Department of Neuroendovascular Therapy, 13600Toranomon Hospital, Tokyo, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center Hospital, Ibaraki, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, 26263Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Kazuya Uemura
- Department of Neurosurgery, 26420Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, 13155Yokomhama City University, Yokohama, Kanagawa, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan.,Division of Stroke Prevention and Treatment, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
6
|
Ng PY. Giant vertebral artery aneurysms presenting acutely with WFNS grade five subarachnoid haemorrhage, report of 4 cases treated with endovascular or surgical proximal parent artery occlusion achieving good functional outcome. J Cerebrovasc Endovasc Neurosurg 2022; 24:63-72. [PMID: 35109646 PMCID: PMC8984643 DOI: 10.7461/jcen.2022.e2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022] Open
Abstract
Ruptured giant aneurysms in the posterior circulation with poor grade subarachnoid haemorrhage (SAH) are associated with poor outcome. In this report four patients with ruptured giant vertebral artery aneurysms who presented acutely with World Federation of Neurosurgical Societies (WFNS) grade five SAH are reviewed. All 4 cases required intubation and ventilation on arrival. Brainstem reflexes were intact in all of them. Early endovascular parent artery coil occlusion was done in two cases. Two other cases were treated with early surgical proximal parent artery clip occlusion. Two cases required ventriculoperitoneal shunting. All cases achieved good recovery with full functional independent outcome at two years follow up. MR angiogram at two years documented resolution of aneurysms. In conclusion good outcome may be possible in some cases of ruptured giant vertebral artery aneurysms with WFNS grade five SAH.
Collapse
Affiliation(s)
- Puay Yong Ng
- Consultant Neurosurgeon, Mount Elizabeth Medical Centre, Singapore 228510, Singapore
| |
Collapse
|
7
|
Verbraeken B, Aboukais R, Voormolen M, Boogaarts HD, Leclerc X, Lejeune JP, Menovsky T. Extreme Lateral Supracerebellar Infratentorial Approach (ELSCIT) for Occipital Artery-to-Posterior Cerebral Artery Bypass: Results in 3 Cases. World Neurosurg 2021; 152:214-220. [PMID: 34023461 DOI: 10.1016/j.wneu.2021.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE/BACKGROUND The need for revascularization of the distal posterior cerebral artery (PCA) in the treatment of PCA aneurysms is a contentious issue. Approaches to the PCA, such as the subtemporal route, carry significant perioperative risk. This risk at times outweighs the risk of ischemia associated with endovascular PCA sacrifice. This paper describes the use of an extreme lateral supracerebellar infratentorial (ELSCIT) approach as an alternative technique for distal PCA revascularization. METHODS Between 2016 and 2019, 3 patients underwent a PCA bypass via the ELSCIT approach for the treatment of a PCA aneurysm. In all cases, an end-to-side anastomosis to the P2- or P3-segment of the PCA was made, with the occipital artery as a donor. Bypass procedures were followed by endovascular parent artery occlusion, without ischemic complications. RESULTS In all 3 cases, the ELSCIT approach offered a broad enough surgical corridor to perform an occipital artery-to-PCA bypass. One patient suffered a cerebrospinal fluid leak that was surgically treated. Patients' clinical conditions were stable on follow-up (mean follow-up of 34 months). All 3 aneurysms remained occluded, and no ischemia was detected on magnetic resonance imaging. CONCLUSIONS The ELSCIT approach offers an alternative route to the distal PCA for extracranial-to-intracranial bypass with seemingly low perioperative morbidity and good surgical access to the PCA.
Collapse
Affiliation(s)
- Barbara Verbraeken
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Rabih Aboukais
- Department of Neurosurgery, Lille University Hospital, Hopital Nord, Lille, France
| | - Maurits Voormolen
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Xavier Leclerc
- Department of Neuroradiology, Lille University Hospital, Hopital Nord, Lille, France
| | - Jean-Paul Lejeune
- Department of Neurosurgery, Lille University Hospital, Hopital Nord, Lille, France
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
8
|
Choi JH, Lee KS, Kim BS, Shin YS. Treatment outcomes of large and giant intracranial aneurysms according to various treatment modalities. Acta Neurochir (Wien) 2020; 162:2745-2752. [PMID: 32827268 DOI: 10.1007/s00701-020-04540-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/16/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to compare the treatment outcomes of large (15-25 mm) and giant (> 25 mm) intracranial aneurysms (IAs), according to different treatment modalities. METHODS In total, 112 patients with large and giant IAs treated with various treatment modalities between January 2009 and December 2018 were retrospectively reviewed. Clinical and radiological parameters were analyzed and correlated with the treatment modality. RESULTS A total of 141 procedures were performed on 112 patients. We initially treated 47 cases with coil embolization, 39 with flow diverter (FD), 13 with direct clipping, and 13 with parent artery occlusion (PAO). Recurrence (46.8%) and retreatment (31.9%) rates were significantly higher in the coiling group (p < 0.001). Complete occlusion rate (36.3%) was significantly lower in the coiling group (p = 0.027). PAO could achieve a high complete occlusion rate (90.9%) with low complication rate (12.5%). The total complication rate was 17%. In the multivariate logistic regression analysis, FD (OR 3.406, p = 0.036) and direct clipping (OR 5.732, p = 0.017) showed a significantly higher complication rate than coiling. The overall mortality rate was 8% (8/139 procedures). At the last follow-up (mean 30.6 ± 26.4 months), 70 of 96 patients (72.9%) showed complete or near-complete occlusion. Good functional outcome (mRS ≤ 2) was observed in 90 of 112 (80.3%) patients at the last follow-up (mean 33.2 ± 30.5 months). CONCLUSIONS Good clinical and radiologic outcomes with acceptable complication and mortality rates can be achieved by various treatment modalities. The selection of appropriate modality should be individualized based on the angiographic findings and clinical symptoms.
Collapse
Affiliation(s)
- Jai Ho Choi
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea
| | - Kwan Sung Lee
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea.
| |
Collapse
|
9
|
Aiura R, Matsumoto M, Mizutani T, Sugiyama T, Tanioka D. Surgical clip occlusion of the V3 segment to prevent recurrent cerebral infarction associated with extracranial vertebral artery dissection: A case report. Surg Neurol Int 2020; 11:337. [PMID: 33194271 PMCID: PMC7656025 DOI: 10.25259/sni_405_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Recurrent cerebral infarction caused by traumatic extracranial vertebral artery dissection (EVAD) is treated medically and surgically. We report a case of EVAD that was treated using surgical clip occlusion of the V3 segment to prevent recurrent cerebral infarction. Case Description: A 48-year-old man was admitted for a cerebral infarction caused by EVAD and was treated using 200 mg/day cilostazol. Afterward, the cerebral infarction recurred. Digital subtraction angiography revealed that initial severe stenosis of the VA ostium resulted in the final occlusion and that collateral vessels to the VA remained. We continued antiplatelet therapy, but the cerebral infarction recurred due to thromboembolism of the collateral vessels. Parent artery occlusion was planned. We exposed the V3 segment of the VA and clipped it to prevent the recurrence of cerebral infarction. Conclusion: Surgical clip occlusion of the V3 segment was effective for treating recurrent cerebral infarction caused by traumatic EVAD that had remained an issue despite continuing medical therapy.
Collapse
Affiliation(s)
- Ryo Aiura
- Department of Neurosurgery, Showa University Hospital, Tokyo, Shinagawa-ku, Japan
| | - Masaki Matsumoto
- Department of Neurosurgery, Showa University Hospital, Tokyo, Shinagawa-ku, Japan
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University Hospital, Tokyo, Shinagawa-ku, Japan
| | - Tatsuya Sugiyama
- Department of Neurosurgery, Showa University Hospital, Tokyo, Shinagawa-ku, Japan
| | - Daisuke Tanioka
- Department of Neurosurgery, Showa University Hospital, Tokyo, Shinagawa-ku, Japan
| |
Collapse
|
10
|
Castaño-Leon AM, Alen JF, Lagares A. Opening of unusual vascular collaterals leads to early recanalization of a giant intracavernous carotid artery aneurysm following common carotid artery occlusion: A Case report and literature review. Surg Neurol Int 2020; 11:62. [PMID: 32363057 PMCID: PMC7193203 DOI: 10.25259/sni_597_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Parent artery occlusion (PAO) with or without bypass surgery is a feasible treatment for large intracavernous carotid artery (ICCA) aneurysms. The ideal occlusion site (internal or common carotid artery [CCA]) and ischemic complications after PAO have received special attention since the description of the technique. Unfrequently, some patients can also develop unusual external carotid artery-internal carotid artery collateral pathways distal to the ligation site that can explain the failure to aneurysm size reduction. Case Description: We describe a rare case of delayed refilling of a large ICCA aneurysm partially thrombosed which early recanalized after surgical ligation of the cervical CCA through an unusual collateral pathway. Conclusion: Based on our experience, we recommend periodic long-term follow-up neuroimaging, especially in those cases where potential collateral branches have not been clearly identified in the preoperative studies.
Collapse
Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Jose F Alen
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| |
Collapse
|
11
|
Tsuji Y, Miki T, Kakita H, Sato K, Yoshida T, Shimizu F. Parent Artery Occlusion for Treatment of a Traumatic Pericallosal Artery Aneurysm: Case Report and Review of the Literature. World Neurosurg 2020; 140:193-197. [PMID: 32360925 DOI: 10.1016/j.wneu.2020.04.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Traumatic intracranial aneurysms are rare complications after head trauma. This report describes the case of a patient with a traumatic pericallosal aneurysm. CASE DESCRIPTION A 73-year-old man developed headache and lower limb paresis, and emergency computed tomography scan revealed a hematoma in the corpus callosum. We performed coil embolization for a pericallosal aneurysm, but follow-up angiography showed recurrence of the aneurysm 6 days after the surgery. We diagnosed this as a traumatic aneurysm and subsequently performed parent artery occlusion without any complications. CONCLUSIONS We performed parent artery occlusion for a traumatic aneurysm of the pericallosal artery without complications. Pericallosal aneurysms are rare, but we must consider them when encountering a delayed hematoma around the corpus callosum.
Collapse
Affiliation(s)
- Yuichiro Tsuji
- Department of Neurosurgery, Osaka Medical College, Osaka, Japan.
| | - Takanori Miki
- Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan
| | - Hiroto Kakita
- Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan
| | - Kimitoshi Sato
- Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan
| | | | | |
Collapse
|
12
|
Kim YS, Ha MH, Joo SP, Kim TS. Acute Parent Artery Occlusion in Thrombosed Middle Cerebral Artery Aneurysm Presenting with Ischemic Stroke. World Neurosurg 2020; 136:122-127. [PMID: 31953097 DOI: 10.1016/j.wneu.2020.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Thrombosed intracranial aneurysms are complex and unstable lesions that are especially associated with ischemic stroke. Although acute parent artery occlusion manifesting with ischemic stroke is very rare, it can lead to catastrophic consequences. CASE DESCRIPTION This study presents 2 cases of acute parent artery occlusion in thrombosed large and giant middle cerebral artery bifurcation aneurysms manifesting with ischemic stroke. Both patients were successfully treated with emergent double-barrel superficial temporal artery-to-middle cerebral artery bypass followed by aneurysm trapping. CONCLUSIONS Emergent superficial temporal artery-to-middle cerebral artery bypass could be a salvageable treatment option in patients with progressive neurologic deficits and significant mismatch between diffusion- and perfusion-weighted imaging in acute parent artery occlusions associated with large or giant thrombosed aneurysms. Besides diffusion- and perfusion-weighted imaging, preoperative assessment of the collaterals will help in predicting postoperative prognosis.
Collapse
Affiliation(s)
- You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Myeong-Hun Ha
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
| |
Collapse
|
13
|
Hou K, Li G, Xu B, Xu K, Yu J. Which Patients with Aneurysms Involving the a1-a2 Segment of the Anterior Inferior Cerebellar Artery Would Benefit from Parent Artery Occlusion? World Neurosurg 2019; 126:301-309. [PMID: 30885868 DOI: 10.1016/j.wneu.2019.03.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Anterior inferior cerebellar artery (AICA) trunk aneurysms are rare entities. Given the eloquence of the AICA in supplying the cerebellum and brainstem, in theory, sacrifice or occlusion of the a1-a2 segment in lesions involving the AICA may lead to various complications. However, some patients might experience no complication or favorable recovery. The subgroup of patients who would benefit from parent artery occlusion (PAO) among those with aneurysms involving the a1-a2 segment of the AICA remains to be explored. In this report, we present 2 cases of AICA dissecting aneurysms at the a1-a2 segment that were successfully occluded via coiling without postprocedural complications. A comprehensive literature review was also performed on patients with AICA aneurysms with occlusion at the a1-a2 segment. Sixteen patients were identified, and all of the cases had satisfactory outcomes. Of these patients, 11 of 16 (68.75%) had no neurologic deficits, and 5 of 16 (31.25%) had acceptable neurologic deficits. The prognosis was associated with collateral circulation of the AICA, and collateral circulation was discussed. In case of an a1-a2 aneurysm that is hard to occlude without sacrificing the parent artery, careful hemodynamic and morphologic evaluation for collateral flow is warranted. If collateral flow is demonstrated or the aneurysm is flow-related with cerebellar arteriovenous malformation, PAO of the a1-a2 segment can be an acceptable option.
Collapse
Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
14
|
Yan P, Zhang Y, Liang F, Ma C, Liang S, Guo F, Jiang C. Comparison of Safety and Effectiveness of Endovascular Treatments for Unruptured Intracranial Large or Giant Aneurysms in Internal Carotid Artery. World Neurosurg 2019; 125:e385-e391. [PMID: 30703601 DOI: 10.1016/j.wneu.2019.01.082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To analyze and compare safety and efficacy of different endovascular treatment modalities for unruptured intracranial large or giant aneurysms. METHODS We retrospectively reviewed 126 consecutive patients with 128 large (15-24 mm) or giant (≥25 mm) aneurysms that were treated with different endovascular procedures between January 2014 and February 2017. We compared clinical and angiographic outcomes and occurrence of technical events among 3 treatment modalities. RESULTS Complete occlusion at last follow-up was achieved in 65.6%, 90.5%, and 72.0% of aneurysms in stent-assisted coiling, parent artery occlusion, and Pipeline embolization device (PED) groups (P = 0.119). Complete occlusion rate at 6-month follow-up (odds ratio = 1.81, P = 0.396) and at last angiographic follow-up (odds ratio = 3.64, P = 0.123), was not superior with parent artery occlusion compared with PED. Retreatment rate was significantly different among all groups (P < 0.001); the rate was highest in the stent-assisted coiling group (21.9%). Rates of hemorrhagic events and ischemic events were not significantly different among groups (P = 0.581). Mass effect exacerbation was more frequently seen in the stent-assisted coiling group (24.4% vs. 7.7% and 3.3%, P = 0.004). Major complication rate was higher in the parent artery occlusion group compared with the PED group, but the difference was not statistically significant (19.2% vs. 16.4%, odds ratio = 1.21, P = 0.763). Rate of technical events was significantly different in the 3 groups (P = 0.0437), and technical events occurred more often in the PED group (18.0%). CONCLUSIONS For large and giant aneurysms located in the internal carotid artery, outcome for endovascular treatment remains poor, even with the introduction of PED.
Collapse
Affiliation(s)
- Peng Yan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yupeng Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Liang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Feng Guo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
15
|
Lee W, Shin YS, Kim KH, Kim YB, Hong CK, Chung J. Preliminary Experience with Vascular Plugs for Parent Artery Occlusion of the Carotid or Vertebral Arteries. J Cerebrovasc Endovasc Neurosurg 2016; 18:208-214. [PMID: 27847763 PMCID: PMC5104844 DOI: 10.7461/jcen.2016.18.3.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to report the authors' preliminary experience using the Amplatzer Vascular Plug (AVP) (St. Jude Medical, Plymouth, MN, USA) for parent artery occlusion of the internal carotid artery (ICA) or vertebral artery (VA). MATERIALS AND METHODS Between September 2008 and December 2015, we performed 52 therapeutic parent artery occlusions (PAOs) by an endovascular technique. Among them, 10 patients underwent PAO of the carotid or vertebral arteries using AVPs. Clinical and radiographic data of these patients were retrospectively reviewed. RESULTS The devices were used for VA dissection that presented with subarachnoid hemorrhage (SAH) in five patients, traumatic arteriovenous fistula (AVF) in two patients, spontaneous AVF in one patient, recurrence of carotid-cavernous fistula (CCF) in one patient, and symptomatic unruptured giant ICA aneurysm in one patient. The devices were used in conjunction with detachable and/or pushable coils and in the extracranial segments of the ICA or VA. Complete occlusion of the parent artery was achieved in all patients. There was one intra-procedural rupture of the VA dissection during coiling prior to using the device. CONCLUSION Results from the current series suggest that the AVP might be used for therapeutic PAO in the extracranial segments of the ICA or VA.
Collapse
Affiliation(s)
- Woosung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.; Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
16
|
Yamaguchi S, Horie N, Hayashi K, Fukuda S, Morofuji Y, Hiu T, Izumo T, Morikawa M, Matsuo T. Point-by-point parent artery/sinus obliteration using detachable, pushable, 0.035-inch coils. Acta Neurochir (Wien) 2016; 158:2089-2094. [PMID: 27586124 DOI: 10.1007/s00701-016-2946-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parent artery occlusion for intractable aneurysms or sinus packing for dural arteriovenous fistulas (DAVFs) is sometimes difficult and requires many expensive coils to accomplish complete occlusion. To help solve these problems, we reviewed our experience using 0.035-inch coil (0.035 coil; Boston Scientific, San Leandro, CA, USA), which has been used in cardiovascular and abdominal lesions. METHODS These 0.035 coils were preferably used in addition to the detachable and fibered coils for patients with intractable aneurysms, traumatic vessel blowout, and DAVF. Our strategy was as follows: (1) detachable coils were deployed first for the ideal anchoring of the coils; (2) small fibered coils were additionally deployed to stabilize the coil mass; (3) 0.035 coils were deployed to complete the occlusion. RESULTS From January 2012 to December 2013, seven consecutive patients were treated by endovascular embolization with 0.035 coils. Reasons for intervention were parent artery occlusion for carotid blowout (n = 1), internal carotid artery aneurysm (n = 2), traumatic vertebral artery injury (n = 2), vertebral AVF (n = 1), and transverse sinus-sigmoid sinus DAVF (n = 1). In our cases, a mean of 20.1 ± 8.5 coils per vessel were placed, and mean total coil length was 258.4 ± 91.5 cm per vessel. All procedures were safely performed and complete occlusions achieved. CONCLUSIONS From our initial experience and treatment results, we believe endovascular parent artery occlusion or sinus packing with 0.035 coils to be useful in terms of reducing the number and expense of coils and also accomplishing immediate occlusion.
Collapse
Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501.
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| | - Kentaro Hayashi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| | - Shuji Fukuda
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| | - Yoichi Morofuji
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| | - Takeshi Hiu
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| | - Minoru Morikawa
- Department of Radiological Science, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| | - Takayuki Matsuo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan, 852-8501
| |
Collapse
|
17
|
Sturiale CL, De Waure C, Della Pepa GM, Calabrò GE, Albanese A, D'Argento F, Fernandez E, Olivi A, Puca A, Pedicelli A, Marchese E. Endovascular Treatment of the Posterior Cerebral Artery Aneurysms: Single-Center Experience and a Systematic Review. World Neurosurg 2016; 91:154-62. [PMID: 27062918 DOI: 10.1016/j.wneu.2016.03.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endovascular treatment of posterior cerebral artery aneurysms is challenging because of the particular features of posterior circulation vessels. We performed a systematic review of the literature, to assess safety and efficacy associated to their endovascular treatment. METHODS Through a literature search, we identified 20 studies that met our inclusion criteria. We also performed a retrospective analysis of patients treated at our institution during the last 10 years. Demographics, angiographic features, clinical presentation, and outcome were extracted from each study. Data were combined using a random effects model and heterogeneity was assessed by I(2). RESULTS We retrieved 7 patients from our institutional series and 246 from the literature. Overall, 253/259 patients/aneurysms were included in this study. A selective coiling was performed in 27% of cases, a stent-assisted coiling in 2%, and a parent artery occlusion in 62%. Immediate complete/near-complete occlusion was obtained in 96% of cases and maintained in 90% at follow-up. No differences were observed between ruptured and unruptured aneurysms. Ischemic complications were reported in 15% of cases, although the most frequent was a hemianopsia in 7%; a hemiparesis was reported in only 2% of cases. Mortality was overall 1%. Ischemic complications were more frequent among patients who underwent nonselective treatment (P < 0.01). CONCLUSIONS Endovascular treatment of posterior cerebral artery aneurysms is associated with increased degree of occlusion and low recurrence rate. However, a parent artery occlusion implies complications, even although most of them are minor events such as hemianopsia.
Collapse
Affiliation(s)
| | - Chiara De Waure
- Institute of Public Health, Catholic University School of Medicine, Rome, Italy
| | | | | | - Alessio Albanese
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Francesco D'Argento
- Institute of BioImaging, Catholic University School of Medicine, Rome, Italy
| | - Eduardo Fernandez
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Alfredo Puca
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | | | - Enrico Marchese
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| |
Collapse
|