Surgical Decompression and Coil Removal for the Recovery of Vision after Coiling and Proximal Occlusion of a Clinoidal Segment Aneurysm: Technical Case Report

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. E1217-E1217 ◽  
Author(s):  
Rabih G. Tawk ◽  
Hunaldo J. Villalobos ◽  
Elad I. Levy ◽  
L Nelson Hopkins
Keyword(s):  
Endovascular Treatment ◽  
Vision Loss ◽  
Cerebral Aneurysms ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Aneurysm Rupture ◽  
Surgical Decompression ◽  
Endovascular Coiling ◽  
High Dose ◽  
Proximal Occlusion

Abstract OBJECTIVE: We present the case of a patient with continued deterioration of vision after endovascular treatment of an unruptured clinoidal segment aneurysm. In conjunction with a review of the literature, the findings in this case highlight the need for further refinements in our understanding of pathophysiological changes induced by coiling of cerebral aneurysms, especially those in aneurysms producing signs and symptoms relating to mass effect. CLINICAL PRESENTATION: The patient is a 45-year-old man who presented with progressive vision loss. Imaging studies revealed a large, clinoidal segment aneurysm. The patient continued to experience progressive vision loss despite treatment with endovascular coiling, proximal occlusion, and high-dose steroid medication. INTERVENTION: The patient underwent a craniotomy for decompression of the optic nerve and for salvage of vision. Clipping of the distal vessel was performed, and the coil mass was removed. The patient experienced marked improvement of central vision after the surgical procedure. CONCLUSION: Although endovascular treatment of aneurysms protects most patients from aneurysm rupture, this case illustrates the fact that coiling, followed by proximal occlusion, might fail to alleviate symptoms related to mass effect. Our experience in this case suggests that early surgical decompression may be indicated for patients presenting with progressive visual deterioration.

scholarly journals Stent-Assisted Coiling of Cerebral Aneurysms: A Multicenter Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Maxim Mokin ◽  
Christopher T Primiani ◽  
Keaton Piper ◽  
David Fiorella ◽  
Ansaar Rai ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cerebral Aneurysms ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Complete Occlusion ◽  
Low Profile ◽  
Grade Scale ◽  
The Difference

Abstract INTRODUCTION New devices have allowed endovascular stent-assisted coiling for the treatment of cerebral aneurysms. It remains unknown how each type of stent affects the safety, efficacy, and clinical outcomes of the stent-coiling procedure. METHODS This study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Vi_sualized Intraluminal Support (LVIS) stents. Cases of aneurysms treated with more than one type of stents (NEU, EP, LVIS) used for coiling of the same lesion (n = 24) or other devices (n = 32) were excluded. Patient characteristics, angiographic results using the Raymond-Roy grade scale (RRGS), clinical outcomes and procedural complications were analyzed in our study. Patients data was retrospectively collected from 6 academic centers. RESULTS A total of 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n = 182; EP, n = 158; LVIS, n = 330) were included in final analysis. Patient characteristics included mean age 56 ? 12 yr old, female prevalence 74% and aneurysm rupture on initial presentation of 19%. The degree of occlusion at baseline angiography was significantly associated with age (P = .002), location by circulation (P = .002), aneurysm size (P = .009), and rupture status (P = .013). We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64% (210/326); NEU 56% (95/169); EP 48% (68/143); P = .008. The difference of complete occlusion on 10.5 mo (mean) and 8 mo (median) angiographic follow-up was also significant: LVIS 84% (251/299); NEU 78% (117/150); EP 67% (83/123); P = .004. There were 7% (47/670) intraprocedural complications and 11.5% (73/632) postprocedural related complications in our cohort. CONCLUSION There were significant affects based on type of stent used for assisted coiling in the immediate and long-term angiographic outcomes in our cohort. Randomized prospective trials are warranted to compare stent types and clinical outcome.

DELAYED VISUAL DEFICITS AND MONOCULAR BLINDNESS AFTER ENDOVASCULAR TREATMENT OF LARGE AND GIANT PARAOPHTHALMIC ANEURYSMS

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 469-475 ◽  
Author(s):  
Raymond D. Turner ◽  
James V. Byrne ◽  
Michael E. Kelly ◽  
Aristotelis P. Mitsos ◽  
Vivek Gonugunta ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Case Series ◽  
Mass Effect ◽  
Endovascular Coiling ◽  
Visual Deterioration ◽  
Paraclinoid Aneurysms ◽  
Bare Platinum Coils ◽  
Platinum Coils

ABSTRACT OBJECTIVE Paraophthalmic aneurysms may exert mass effect on the optic apparatus. Although surgical clipping and endovascular coiling of these aneurysms can be complicated by immediate postoperative visual deterioration, endovascular coil embolization has the unique risk of visual complications later (>24 h) in the perioperative period. METHODS Six patients with a delayed onset of vision loss after technically successful coil embolization of paraophthalmic region aneurysms were identified. All available clinical, angiographic, and cross sectional imaging for these patients, in addition to histopathological data, were reviewed. RESULTS Six patients who underwent endovascular treatment of paraclinoid aneurysms at our institutions developed delayed postoperative visual decline. Four were treated with combination hydrogel-coated and bare platinum coils, one with hydrogel-coated coils, and one with bare platinum coils. Three patients presented with some degree of visual impairment caused by their aneurysms. Catheter angiography performed after the visual decline revealed no etiology in any of the cases. Magnetic resonance imaging was performed in all patients and was unremarkable in two. At follow-up, two had improved, three remained unchanged, and one patient died before any follow-up assessment of her vision. CONCLUSION Both acute and delayed visual disturbances can present after the endovascular treatment of carotid artery paraophthalmic aneurysms. Delayed visual deterioration can be observed up to 35 days after embolization. Although the cause is still undefined, it is likely that the more delayed visual deterioration can be attributed to progression of mass effect and/or perianeurysmal inflammatory change. Our case series raises the possibility that this phenomenon may be more likely with HydroCoil (HydroCoil Embolic System; MicroVention, Aliso Viejo, CA). This possibility should be taken into account by neurointerventionists when selecting a coil type to treat large paraophthalmic aneurysms.

scholarly journals Progressive enlargement of a previously coiled posterior inferior cerebellar artery aneurysm

2015 ◽  
Author(s):  
Michael Karsy ◽  
Aaron Cutler ◽  
Christian Bowers ◽  
Richard Schmidt
Keyword(s):  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Endovascular Coiling ◽  
Ct Angiogram ◽  
Cerebellar Artery

Multidisciplinary treatment of cerebral aneurysms includes endovascular coiling and open neurosurgical clipping techniques, however our understanding of long-term outcomes after coiling of large cerebral aneurysms remains limited. We present a case involving the development of a previously coiled posterior inferior cerebellar artery (PICA) aneurysm in a 64-year-old man with lesion enlargement and symptomatic mass effect. CT angiogram demonstrated a 3.9×2.6×2.4-cm partially thrombosed aneurysm adjacent to the left vertebral artery. The patient underwent resection to relieve the compressive effect. We discuss the efficacy of endovascular coiling and surgical clipping in this case as well as review the relevant literature.

Stent-assisted coiling of cerebral aneurysms: multi-center analysis of radiographic and clinical outcomes in 659 patients

2019 ◽  
Vol 12 (3) ◽  
pp. 289-297 ◽  
Author(s):  
Maxim Mokin ◽  
Christopher T Primiani ◽  
Zeguang Ren ◽  
Keaton Piper ◽  
David J Fiorella ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Patient Characteristics ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Complete Occlusion ◽  
Stent Type ◽  
Low Profile ◽  
Grade Scale ◽  
Procedural Complications ◽  
The Difference

IntroductionThe endovascular stent-assisted coiling approach for the treatment of cerebral aneurysms is evolving rapidly with the availability of new stent devices. It remains unknown how each type of stent affects the safety and efficacy of the stent-coiling procedure.MethodsThis study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Visualized Intraluminal Support (LVIS) stents. Patient characteristics, treatment details and angiographic results using the Raymond–Roy grade scale (RRGS), and procedural complications were analyzed in our study.ResultsOur study included 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n=182; EP, n=158; LVIS, n=330) that were retrospectively collected from six academic centers. Patient characteristics included mean age 56.3±12.1 years old, female prevalence 73.9%, and aneurysm rupture on initial presentation of 18.8%. We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64.4%, 210/326; NEU 56.2%, 95/169; EP 47.6%, 68/143; P=0.008. The difference of complete occlusion on 10.5 months (mean) and 8 months (median) angiographic follow-up remained significant: LVIS 84%, 251/299; NEU 78%, 117/150; EP 67%, 83/123; P=0.004. There were 7% (47/670) intra-procedural complications and 11.5% (73/632) post-procedural-related complications in our cohort. Furthermore, procedure-related complications were higher in the braided-stents vs laser-cut, P=0.002.ConclusionsThere was a great variability in techniques and choice of stent type for stent-assisted coiling among the participating centers. The type of stent was associated with immediate and long-term angiographic outcomes. Randomized prospective trials comparing the different types of stents are warranted.

Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992

1997 ◽  
Vol 87 (2) ◽  
pp. 141-162 ◽  
Author(s):  
Charles G. Drake ◽  
Sydney J. Peerless
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
Collateral Vessels ◽  
Proximal Occlusion

✓ The paucity of information about giant fusiform intracranial aneurysms prompted this review of 120 surgically treated patients. Twenty-five aneurysms were located in the anterior and 95 in the posterior circulation. Six patients suffered from atherosclerosis and only three others had a known arteriopathy. The remaining 111 patients presented with aneurysms resulting from an unknown arterial disorder; these patients were much younger than those harboring atherosclerotic aneurysms. Mass effect occurred in only 50% of cases and hemorrhage in 20%. Eight aneurysms caused transient ischemic attacks. Hunterian proximal occlusion or trapping were dominant among the treatment methods. In contrast to the management of giant saccular aneurysms, the usual thrombotic occlusion of a giant fusiform aneurysm after proximal parent artery occlusion requires the presence of two collateral circulations to prevent infarction, one for the end vessels and another for the perforating vessels that arise from the aneurysm. Although there was some reliance on the circle of Willis and on collateral vessels manufactured at surgery, the extent of natural leptomeningeal and perforating collateral, thalamic, lenticulostriate, and brainstem vessels was astonishing and formerly unknown to the authors. Good outcome occurred in 76% of patients with aneurysms in the anterior circulation; two of the six cases with poor results included patients who were already hemiplegic. Ninety percent of patients with posterior cerebral aneurysms fared well. Only 67% of patients with basilar or vertebral aneurysms had good outcomes, although more (17%) of these patients were in poor condition preoperatively because of brainstem compression.

scholarly journals Endovascular treatment of fusiform aneurisms of brain vessels

2019 ◽  
Vol 28 (2) ◽  
pp. 59-65
Author(s):  
D.V. Shchehlov ◽  
V.M. Zagorodniy ◽  
O.E. Sviridyuk ◽  
S.V. Konotopchyk
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Mass Effect ◽  
Early Postoperative Period ◽  
Brain Vessels ◽  
Technical Problems ◽  
Surgical Interventions ◽  
Arterial Aneurysms ◽  
Type 3

Objective – to determine the effectiveness of endovascular treatment of fusiform arterial aneurysms of cerebral vessels.Materials and metods. The results of endovascular treatment of 25 patients with fusiform cerebral aneurysms who were treated at the Center in the period from 2011 to 2018 were analyzed. There were 12 men (48 %), women – 13 (52 %). The average age of patients is 48 years. In 17 (68 %) cases were vertebrobasilar aneurysms, in 2 (8 %) cases – aneurysms of the anterior cerebral artery, in 3 (12 %) cases – aneurysms of the middle cerebral artery, in 3 (12 %) cases – aneurysms of internal carotid arteries. For the treatment of patients we used various stents: flow diversion (FRED (Microvention, USA), Pipeline (ev3, USA)), Derivo (Acandis, Germany)) and protection stents (Leo (Balt, France), Solitaire (Medtronic, USA)), in deconstructive interventions – detachable coils.Results. It were performed 25 surgical interventions: in 23 (92 %) cases – reconstructive shutdown, in 2 (8 %) – deconstructive shutdown. There were no technical problems during surgical interventions. Complications were noted in two cases with VBB aneurysms in the early postoperative period stem disorders appeared due to the increasing mass effect. Both patients were dead. Control examination in a period from 6 months to 3 years 13 (52 %) patients were performed. The results of excluding aneurysms were evaluated on a Raymond–Roy scale. The type 1 was detected in 7 (53.8 %) patients, the type 2 – 1 (7.7 %), the type 3 – 5 (38.5 %). In 2 (15.4 %) patients bearing artery thrombosis was detected.Conclusions. Extrasacular endovascular methods of treating fusiform arterial aneurysms of cerebral vessels are effective and relatively safe. They can expand the indications for endovascular treatment of these aneurysms, however compared with the treatment of saccular aneurysms hemodynamic changes and secondary aneurysm thrombosis are unpredictable and require further study.

scholarly journals Progressive enlargement of a previously coiled posterior inferior cerebellar artery aneurysm

2015 ◽  
Author(s):  
Michael Karsy ◽  
Aaron Cutler ◽  
Christian Bowers ◽  
Richard Schmidt
Keyword(s):  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Endovascular Coiling ◽  
Ct Angiogram ◽  
Cerebellar Artery

Multidisciplinary treatment of cerebral aneurysms includes endovascular coiling and open neurosurgical clipping techniques, however our understanding of long-term outcomes after coiling of large cerebral aneurysms remains limited. We present a case involving the development of a previously coiled posterior inferior cerebellar artery (PICA) aneurysm in a 64-year-old man with lesion enlargement and symptomatic mass effect. CT angiogram demonstrated a 3.9×2.6×2.4-cm partially thrombosed aneurysm adjacent to the left vertebral artery. The patient underwent resection to relieve the compressive effect. We discuss the efficacy of endovascular coiling and surgical clipping in this case as well as review the relevant literature.

scholarly journals Non-Atherosclerotic Fusiform Cerebral Aneurysms

2002 ◽  
Vol 29 (1) ◽  
pp. 41-48 ◽  
Author(s):  
J. Max Findlay ◽  
Chunhai Hao ◽  
Derek Emery
Keyword(s):  
Connective Tissue ◽  
Cerebral Aneurysms ◽  
Side Wall ◽  
Endovascular Coiling ◽  
Parent Artery ◽  
Cerebral Atherosclerosis ◽  
Parent Artery Occlusion ◽  
Risk Of Rupture ◽  
Thin Walled ◽  
Proximal Occlusion

Background:Fusiform cerebral aneurysms are dilatations of the entire circumference of a segment of cerebral artery, usually considered due to atherosclerosis in adults. They are relatively thick-walled and elongated, causing neural compression or ischemia when discovered. We have noted a subset of fusiform cerebral aneurysms that vary from this common description.Patients:Out of a series of 472 intracranial aneurysms treated over 11 years, 11 patients between the ages 16 and 67 years (mean age 37) were identified who had discrete fusiform aneurysms unassociated with generalized cerebral atherosclerosis, connective tissue disorder or inflammation. Three presented with hemorrhage, six with neural compression by the aneurysm and two were discovered incidentally.Results:Nine aneurysms were located in the posterior circulation, the other two in the intracranial carotid artery. Their mean length and width were 16.3 and 11 mm, respectively. Three aneurysms contained thrombus. The eight aneurysms that were exposed surgically were partly or substantially thin-walled with normal appearing parent arteries. Eight were treated with proximal occlusion and three were circumferentially “wrapped”. Parent artery occlusion caused one death and one mild disability and the remaining patients made good recoveries (follow-up 0.5 - 10 years).Conclusions:There is a subset of cerebral aneurysms with discrete fusiform morphology, apparently unrelated to cerebral atherosclerosis or systemic connective tissue disease, thin-walled in part or whole, more common in the vertebrobasilar system, and possessing a risk of rupture. Treatments currently available include proximal occlusion or aneurysm “wrapping”, different approaches than neck-clipping or endovascular coiling of side-wall saccular cerebral aneurysms that leave the parent artery intact.

Cerebral aneurysms with intrasellar extension: a systematic review of clinical, anatomical, and treatment characteristics

2012 ◽  
Vol 116 (1) ◽  
pp. 164-178 ◽  
Author(s):  
Brian W. Hanak ◽  
Gabriel Zada ◽  
Vikram V. Nayar ◽  
Ruth Thiex ◽  
Rose Du ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Pituitary Tumors ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Complex Aneurysms ◽  
Treatment Characteristics ◽  
Nerve Paresis ◽  
Modern Era

Object Intrasellar aneurysms are rare lesions that often mimic pituitary tumors, potentially resulting in catastrophic outcomes if they are not appropriately recognized. The authors aimed to characterize the clinical and anatomical details of this poorly defined entity in the modern era of neuroimaging and open/endovascular neurosurgery. Methods A PubMed literature review was conducted to identify all studies reporting noniatrogenic aneurysms with intrasellar extension, as confirmed by CT or MR imaging and angiography. Clinical, anatomical, and treatment characteristics were analyzed. Results Thirty-one studies reporting 40 cases of intrasellar aneurysms were identified. Six patients (15%) presented with aneurysmal rupture. Patients with unruptured aneurysms presented with the following signs and symptoms: headache (61%), visual field cuts/decreased visual acuity (61%), endocrinopathy (57%), symptomatic hyponatremia (21%), and cranial nerve paresis (other than optic nerve) (18%). The most common endocrine abnormalities were hyperprolactinemia and hypogonadism. Eight aneurysms (20%) were diagnosed in conjunction with a pituitary adenoma. Aneurysms could be categorized into 2 primary anatomical groups as follows: 1) cavernous/clinoid segment internal carotid artery (ICA) (infradiaphragmatic) aneurysms with medial extension into the sella; and 2) suprasellar (supradiaphragmatic) aneurysms originating from the ophthalmic segment of the ICA or from the anterior communicating artery, with inferomedial extension into the sella. The mean diameters of infradiaphragmatic and supradiaphragmatic aneurysms were 14.5 and 21.8 mm, respectively. Infradiaphragmatic aneurysms were much more likely to present with endocrinopathy, whereas supradiaphragmatic ones presented more commonly with visual disturbances. Aneurysms with infradiaphragmatic growth were generally treated using either endovascular techniques or surgical trapping and bypass, while supradiaphragmatic aneurysms were more often treated by surgical clipping. Conclusions Aneurysms with intrasellar extension typically present due to mass effect on surrounding structures, and they can be classified as infradiaphragmatic cavernous or clinoid segment ICA aneurysms, or supradiaphragmatic ophthalmic ICA or anterior communicating artery aneurysms. Varying approaches exist for treating these complex aneurysms, and intervention strategies depend substantially on the anatomical subtype.

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