Document Detail


Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.
MedLine Citation:
PMID:  19877778     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.
Authors:
Adam S Reig; Scott Simon; Robert A Mericle
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  4     ISSN:  1933-0715     ISO Abbreviation:  -     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  449-52     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Brain Injuries / complications*
Carotid Artery Diseases / therapy*
Carotid Artery, Internal*
Cerebral Angiography
Child
Dimethyl Sulfoxide / therapeutic use*
Embolization, Therapeutic*
Female
Horner Syndrome / complications
Humans
Intracranial Aneurysm / therapy*
Off-Road Motor Vehicles
Polyvinyls / therapeutic use*
Skull Base / injuries*
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Onyx copolymer; 0/Polyvinyls; 67-68-5/Dimethyl Sulfoxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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