Document Detail


Obliteration of a giant fusiform carotid terminus-M1 aneurysm after distal clip application and extracranial-intracranial bypass. Case report.
MedLine Citation:
PMID:  17571038     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Giant intracranial aneurysms may not be amenable to direct surgical clipping or endovascular coiling because of three critical factors: 1) lack of clear aneurysmal neck; 2) giant size; 3) involvement with critical perforating or branch vessels. Techniques of flow redirection, however, may offer an alternative treatment strategy for these difficult lesions. In this paper, we report on the use of this alternative strategy in the successful treatment of a left giant fusiform carotid terminus-M1 aneurysm in a 16 year-old boy suffering from Ehler-Danlos disease. This patient was admitted to our Institution because his aneurysm was continuing to be increasing in size, despite a previous ligation of his left cervical ICA which was performed at another institution 2 years earlier after the patient had experienced a hemorrhagic stroke. Upon admission, a neurological examination revealed a slight motor aphasia with mild right hemiparesis, remnant of the ancient stroke. Because of its size and the involvement with M1 perforating arteries, a direct aneurysm attack was deemed inadvisable. After an initial ECA-ICA high flow bypass which spontaneously thrombosed, we performed a repeated high flow bypass with the application of a single clip on M1, right distal to the fusiform dilatation. After an uneventful postoperative course, we were unable to observe any new neurological deficits after surgery. A CT scan on postoperative day 1 revealed that the aneurysm had undergone a spontaneous thrombosis which was completely obliterated at the time of a 6-month follow-up angiogram. At that time, the ECA-ICA bypass was found to be patent. In conclusion the alternative of flow alteration strategies can be successfully used in the treatment of aneurysms that cannot be safely trapped or occluded by traditional neurosurgical methods.
Authors:
P Ferroli; E Ciceri; E Parati; L Minati; G Broggi
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgical sciences     Volume:  51     ISSN:  0390-5616     ISO Abbreviation:  J Neurosurg Sci     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-15     Completed Date:  2007-09-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0432557     Medline TA:  J Neurosurg Sci     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  71-6     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milan, Italy. pferroli@istituto-besta.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Carotid Artery, Internal / pathology,  radiography,  surgery*
Cerebral Angiography
Cerebral Revascularization / instrumentation*,  methods*
Cerebrovascular Circulation / physiology
Ehlers-Danlos Syndrome / complications
Humans
Infarction, Middle Cerebral Artery / etiology,  physiopathology,  prevention & control
Intracranial Aneurysm / pathology,  radiography,  surgery*
Magnetic Resonance Imaging
Male
Middle Cerebral Artery / pathology,  radiography,  surgery*
Radial Artery / surgery,  transplantation
Stroke / etiology
Surgical Instruments / standards*
Tomography, X-Ray Computed
Transplants
Treatment Outcome

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


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