Vertebral Artery Aneurysm: Unruptured Dissecting Intradural Right Vertebral Artery Aneurysm with Brainstem Compression; Coil Occlusion of the Aneurysm and the Parent Artery with Resolution of the Mass Effect; Good Clinical Outcome with Long-Term Follow-up

✓ The case is presented of a 5-year-old child who suffered a subarachnoid hemorrhage from a giant left vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm. Initial treatment consisted of surgical occlusion of the parent vertebral artery combined with a PICA-to-PICA bypass. Because of persistent filling of the aneurysm, the left PICA was occluded at its takeoff from the aneurysm. Endovascular coil occlusion of the aneurysm and the distal left vertebral artery enabled complete elimination of the aneurysm. Follow-up magnetic resonance imaging and arteriography performed 6 months postoperatively showed persistent occlusion and elimination of the mass effect. Combined surgical bypass and endovascular occlusion of the parent artery may be a useful adjunct in the management of these aneurysms.

Download Full-text

Giant Vertebrobasilar Aneurysms: Endovascular Treatment and Long-term Follow-up

Neurosurgery ◽

10.1227/01.neu.0000129477.15636.ae ◽

2004 ◽

Vol 55 (2) ◽

pp. 316-326 ◽

Cited By ~ 54

Author(s):

Boris Lubicz ◽

Xavier Leclerc ◽

Jean-Yves Gauvrit ◽

Jean-Paul Lejeune ◽

Jean-Pierre Pruvo

Keyword(s):

Clinical Outcome ◽

Endovascular Treatment ◽

Mass Effect ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Long Term Follow Up ◽

Vertebral Aneurysm ◽

Vertebrobasilar Aneurysms

Abstract OBJECTIVE: To report long-term imaging follow-up and clinical outcome of 13 patients with a giant vertebrobasilar aneurysm treated by parent artery occlusion (PAO). METHODS: From 1994 to 2000, 13 consecutive patients with a giant vertebrobasilar aneurysm were treated by PAO. Symptoms were related to mass effect in nine patients and to a subarachnoid hemorrhage in four. Endovascular treatment consisted of aneurysm trapping in nine patients and occlusion of one or both vertebral arteries in four. We assessed the clinical outcome and imaging findings in all patients during a 28-month period. RESULTS: Endovascular treatment resulted in clinical improvements in eight patients, worsening of symptoms in four, and death in one. One woman with a ruptured vertebral aneurysm died from a rebleeding after PAO without trapping. One man developed a brainstem infarction after lower basilar artery occlusion and incurred hemiparesis. In three patients, symptoms of mass effect increased after the procedure. Long-term follow-up revealed good or excellent clinical outcome in all patients and a sharp decrease in size of the thrombosed aneurysm in nine patients. One basilar aneurysm recanalized despite selective coiling and subsequent bilateral vertebral artery occlusion; one vertebral aneurysm and one basilar aneurysm did not decrease in size despite complete occlusion. CONCLUSION: Giant vertebrobasilar aneurysms are rare and challenging lesions for both neurosurgeons and neurointerventionalists. Their treatment by endovascular PAO remains safe and effective. Early clinical worsening may be observed, but long-term follow-up shows good or excellent results in most patients. This treatment can be carried out with minimal morbidity and mortality using clinical and angiographic monitoring.

Download Full-text

Very Late Thrombosis of a Pipeline Embolization Device Construct

Operative Neurosurgery ◽

10.1227/01.neu.0000383875.08681.23 ◽

2010 ◽

Vol 67 (3) ◽

pp. onsE313-onsE314 ◽

Cited By ~ 49

Author(s):

David Fiorella ◽

Daniel Hsu ◽

Henry H. Woo ◽

Robert W. Tarr ◽

Peter Kim Nelson

Keyword(s):

Vertebral Artery ◽

Artery Aneurysm ◽

Left Vertebral Artery ◽

Pipeline Embolization Device ◽

Complete Occlusion ◽

Brainstem Stroke ◽

Long Term Follow Up ◽

Late Thrombosis

Abstract BACKGROUND: The Pipeline embolization device (PED) is a new endoluminal construct designed to exclude aneurysms from the parent cerebrovasculature. We report the very late (>;1 year) thrombosis of a PED construct placed for the treatment of a left vertebral aneurysm. CLINICAL PRESENTATION: A patient with an occluded right vertebral artery and a large, fusiform intracranial left vertebral artery aneurysm was treated with PED and coil reconstruction. A durable, complete occlusion of the aneurysm was confirmed with control angiography at 1 year. The patient remained neurologically normal for 23 months until he experienced a transient visual disturbance followed weeks later by a minor brainstem stroke. INTERVENTION: Imaging evaluation showed thrombosis of the PED construct with complete occlusion of the left vertebral artery. After this stroke, he was initially treated with dual antiplatelet therapy and was then converted to warfarin. The patient remained neurologically stable for 5 months until he experienced progressive basilar thrombosis that ultimately resulted in a fatal stroke. CONCLUSION: The PED represents a promising new endovascular technology for the treatment of cerebral aneurysms; however, as an investigational device, long-term follow-up data are sparse at this point. The etiology of the very late thrombosis of the PED construct in this case remains unknown; however, this report underscores the need for a continued, careful systematic evaluation and close long-term follow-up of treated patients.

Download Full-text