scholarly journals Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient

2013 ◽  
Vol 19 (2) ◽  
pp. 222-227 ◽  
Author(s):  
S.H. Shin ◽  
I.S. Choi ◽  
K. Thomas ◽  
C.A. David
Keyword(s):  
Pediatric Patient ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Endovascular Management ◽  
Excellent Outcome ◽  
Parent Artery Occlusion

Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

Revascularization and Parent Artery Occlusion for Giant Internal Carotid Artery Aneurysms in the Intracavernous Portion Using Intraoperative Monitoring of Cerebral Hemodynamics

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Yoshitaka Kubo ◽  
Kuniaki Ogasawara ◽  
Nobuhiko Tomitsuka ◽  
Yasunari Otawara ◽  
Shunsuke Kakino ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
High Flow ◽  
Parent Artery ◽  
Bypass Grafting ◽  
Parent Artery Occlusion

Abstract OBJECTIVE: Therapeutic parent artery occlusion with or without revascularization is a useful surgical technique for the management of a giant aneurysm located in the intracavernous portion of the internal carotid artery (ICA). The purpose of the present study was to determine whether intraoperative cortical blood flow (CoBF) monitoring during surgical parent artery occlusion could identify patients who required bypass with a saphenous vein graft (high flow bypass). METHODS: Eleven patients with a giant aneurysm located in the intracavernous portion of the ICA underwent superficial temporal artery-middle cerebral artery bypass. CoBF was monitored intraoperatively in all patients using a thermal diffusion flow probe. The lowest CoBF during test occlusion of the ICA under functioning superficial temporal artery-middle cerebral artery bypass was determined, and the ratio of the value to the CoBF immediately before test occlusion of the ICA was calculated in the frontal and temporal lobes. When the CoBF ratio in the frontal or temporal lobe was less than 0.9, high flow bypass grafting was elected. RESULTS: Of the eleven patients undergoing superficial temporal artery-middle cerebral artery bypass, five patients underwent concomitant high flow bypass grafting. Postoperative cerebral ischemic events did not occur in any patient over a follow-up period ranging from 3 to 60 months. Postoperative cerebral angiography showed resolution of the aneurysm and patency of the bypass in all patients. CONCLUSION: Intraoperative CoBF monitoring using a thermal diffusion flow probe during surgical parent artery occlusion for giant intracavernous carotid artery aneurysms can identify patients who require concomitant high flow bypass grafting.

Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion

2014 ◽  
Vol 14 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Adib A. Abla ◽  
Hasan A. Zaidi ◽  
R. Webster Crowley ◽  
Gavin W. Britz ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Thrombus Formation ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Mass Effect ◽  
Parent Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Unsuccessful Treatment ◽  
Parent Artery Occlusion

Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery–middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm. Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED.

Endovascular stenting for rescue of a failed donor graft during superficial temporal artery to middle cerebral artery bypass surgery: case report

2019 ◽  
Vol 24 (5) ◽  
pp. 572-576
Author(s):  
Melissa A. LoPresti ◽  
Visish M. Srinivasan ◽  
Robert Y. North ◽  
Vijay M. Ravindra ◽  
Jeremiah Johnson ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Endovascular Management ◽  
Donor Graft ◽  
Mca Aneurysm ◽  
Direct Bypass

Direct bypass has been used to salvage failed endovascular treatment; however, little is known of the reversed role of endovascular management for failed bypass.The authors report the case of a 7-year-old patient who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass for treatment of a giant MCA aneurysm and describe the role of endovascular rescue in this case. Post-bypass catheter angiogram showed occlusion of the proximal extracranial STA donor with patent anastomosis, possibly due to STA dissection. A self-expanding Neuroform Atlas stent was deployed across the dissection flap, and follow-up images showed revascularization of the STA with good MCA runoff.This case demonstrates that direct extracranial-intracranial bypass failure can infrequently originate from the STA donor vessel and that superselective angiogram can be useful for identification and treatment in such cases. With more advanced endovascular techniques the tide has turned in the treatment of complex cerebrovascular cases, with this case being an early example of successful rescue stenting for endovascular management of a failed donor after STA-MCA bypass.

A Surgical Case of Delayed Coil Migration After Balloon-Assisted Embolization of an Intracranial Broad-Neck Aneurysm: Case Report

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. onsE516-onsE521 ◽  
Author(s):  
Hiroaki Motegi ◽  
Masanori Isobe ◽  
Toyohiko Isu ◽  
Hiroyasu Kamiyama
Keyword(s):  
Coil Embolization ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Tension Headache ◽  
Temporal Artery ◽  
Carotid Bifurcation ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Ischemic Attack ◽  
Coil Migration

ABSTRACT BACKGROUND AND IMPORTANCE: Balloon-assisted coil placement is an important technique for coil embolization of broad-neck aneurysms. With this technique, we can prevent coil migration into a parent artery during a procedure. Complications of intraprocedural coil migration have been reported in the literature. However, delayed coil migration is extremely rare. We present a case of delayed coil migration after balloon-assisted coil embolization and describe our management of this complication. CLINICAL PRESENTATION: A 59-year-old man presented with hypertension and a tension headache. Clinical evaluation incidentally discovered an unruptured broad-neck aneurysm at the left internal carotid bifurcation. Endovascular embolization of the aneurysm was performed with a balloon-assisted technique. The patient had a transient ischemic attack, and a skull radiograph showed coil migration 3 months after the procedure. We performed an operation to remove the coils and to clip the aneurysm with superficial temporal artery and middle cerebral artery bypass. The patient was discharged without neurological deficit. CONCLUSION: This is a rare case in which delayed coil migration into the parent artery occurred after balloon-assisted coil embolization, highlighting the importance of surgical management of delayed coil migration.

Endovascular obliteration of an intracranial pseudoaneurysm: the utility of Onyx

2009 ◽  
Vol 4 (5) ◽  
pp. 445-448 ◽  
Author(s):  
Ricky Medel ◽  
R. Webster Crowley ◽  
D. Kojo Hamilton ◽  
Aaron S. Dumont
Keyword(s):  
Pediatric Patient ◽  
Coil Embolization ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Potential Treatment ◽  
Parent Artery Occlusion ◽  
Endovascular Methods ◽  
Iatrogenic Pseudoaneurysm

Pseudoaneurysms are rare lesions with a multitude of causes, including infectious, traumatic, and iatrogenic origins. In addition, there are a number of potential treatment options, all of which require consideration to determine the most appropriate management. Historically, surgical intervention has been the method of choice, but because the histopathological features of these lesions make them largely unsuitable for clipping, trapping or excision is often required. More recently endovascular methods have been used, including coil embolization, stent reconstruction, or parent artery occlusion. Although these methods are often successful, situations arise in which they are not technically feasible. The authors describe such a case in a pediatric patient with an iatrogenic pseudoaneurysm. Onyx was used to embolize the lesion and the results were excellent.

Intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis: A case report

2020 ◽  
pp. 159101992096535
Author(s):  
Ken Uekawa ◽  
Yasuyuki Kaku ◽  
Toshihiro Amadatsu ◽  
Hiroaki Matsuzaki ◽  
Yuki Ohmori ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Coil Embolization ◽  
De Novo ◽  
Superficial Temporal Artery ◽  
Vascular Complications ◽  
Temporal Artery ◽  
Left Internal Carotid Artery ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Dissecting Aneurysms

Objective We describe a case of intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis (RA). Case Presentation A 29-year-old man with a medical history of RA since 18 years of age was admitted to our hospital for vomiting, dysarthria, and conscious disturbance. At 23, he underwent ligation of the left internal carotid artery (ICA) with superficial temporal artery to middle cerebral artery anastomosis because of acute infarct of the left hemisphere caused by arterial dissection of the left ICA. During the current admission, computed tomography (CT) revealed subarachnoid hemorrhage, and digital subtraction angiography (DSA) demonstrated dissecting aneurysms of the left intracranial vertebral artery (VA) and right extracranial VA. We diagnosed him with a ruptured dissecting aneurysm of the left intracranial VA and performed endovascular parent artery occlusion on the left VA. For the right unruptured VA aneurysm, we performed coil embolization simultaneously. At 2 weeks after the endovascular treatment, follow-up DSA revealed that multiple de novo dissecting aneurysms developed on the origin of the left VA and left and right internal thoracic arteries. Those aneurysms were treated with coil embolization. Other remaining aneurysms on the left thyrocervical trunk, right transverse cervical artery, and both common iliac arteries were treated by conservative therapy. While continuing medical treatment for RA, the patient recovered and was discharged to a rehabilitation hospital. Conclusion Considering that RA-induced vasculitis can be a potential risk of vascular complications including multiple arterial dissections, physicians should carefully perform endovascular interventional procedures for patients with long-term RA.

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