Document Detail

Symptomatic enlargement of an occluded giant carotido-ophthalmic aneurysm after endovascular treatment: the vasa vasorum theory.
MedLine Citation:
PMID:  19343269     Owner:  NLM     Status:  MEDLINE    
We describe a patient with a symptomatic left giant carotido-ophthalmic aneurysm who initially underwent coil embolization with subtotal obliteration. The patient's symptoms were initially stable, but 1 year later, she presented with a rapidly progressive contralateral visual deficit. Although angiogram showed a stable neck remnant, MR confirmed aneurysm growth and showed a new peripheral hematoma in the wall of the thrombosed aneurysm. Surgical exploration was undertaken, and even after trapping and intra-aneurysmal thrombectomy, constant bleeding was observed from the wall of the thrombosed aneurysm consistent with the vasa vasorum. Bleeding stopped after cauterization and partial resection of the aneurysm dome, and the aneurysm was clipped. The patient's recent visual deficit markedly improved, and the angiogram did not reveal any residue. Giant aneurysms may continue to grow due to a hypertrophic vasa vasorum and subadventitial hemorrhages. Surgery should be considered if complete thrombosis of the aneurysm does not alleviate patient's symptoms.
Amir R Dehdashti; Laurent Thines; Robert A Willinsky; Michael Tymianski
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-04-03
Journal Detail:
Title:  Acta neurochirurgica     Volume:  151     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-25     Completed Date:  2009-11-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  1153-8     Citation Subset:  IM    
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
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MeSH Terms
Carotid Artery, Internal / pathology,  radiography,  surgery
Carotid Artery, Internal, Dissection / pathology*,  radiography,  therapy
Cerebral Angiography
Disease Progression
Embolization, Therapeutic / adverse effects*
Hematoma / pathology,  radiography,  therapy
Intracranial Aneurysm / pathology*,  radiography,  therapy
Middle Aged
Ophthalmic Artery / pathology*,  physiopathology,  radiography
Postoperative Complications / etiology*,  pathology*,  physiopathology
Recurrence / prevention & control
Surgical Instruments
Treatment Outcome
Vasa Vasorum / pathology,  physiopathology
Vision, Low / etiology,  physiopathology,  therapy

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