Abstract
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.
References
Aydin F (1998) Do human intracranial arteries lack vasa vasorum? A comparative immunohistochemical study of intracranial and systemic arteries. Acta Neuropathol (Berl) 96:22–28
Gonzalez NR, Duckwiler G, Jahan R, Murayama Y, Vinuela F (2006) Challenges in the endovascular treatment of giant intracranial aneurysms. Neurosurgery 59:S113–124 discussion S113–113
Halbach VV, Higashida RT, Dowd CF, Barnwell SL, Fraser KW, Smith TP, Teitelbaum GP, Hieshima GB (1994) The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg 80:659–666
Hirasawa T, Tsubokawa T, Katayama Y, Koike Y, Ueno Y, Hirayama T, Himi K (1992) Growth of a giant aneurysm following complete thrombosis by detachable balloon occlusion. Surg Neurol 38:283–286
Iihara K, Murao K, Sakai N, Soeda A, Ishibashi-Ueda H, Yutani C, Yamada N, Nagata I (2003) Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum. Case report. J Neurosurg 98:407–413
Krings T, Alvarez H, Reinacher P, Ozanne A, Baccin CE, Gandolfo C, Zhao WY, Reinges MHT, Lasjaunias P (2007) Growth and rupture mechanism of partially thrombosed aneurysms. Interventional neuroradiology 13:117–126
Lawton MT, Quinones-Hinojosa A, Chang EF, Yu T (2005) Thrombotic intracranial aneurysms: classification scheme and management strategies in 68 patients. Neurosurgery 56:441–454 discussion 441–454
Yasargil MG (1984) Clinical considerations, surgery of the intracranial aneurysms and results in Microneurosurgery. Stuttgart, Thieme
Molyneux AJ, Ellison DW, Morris J, Byrne JV (1995) Histological findings in giant aneurysms treated with Guglielmi detachable coils. Report of two cases with autopsy correlation. J Neurosurg 83:129–132
Nagahiro S, Takada A, Goto S, Kai Y, Ushio Y (1995) Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg 82:796–801
Pero G, Denegri F, Valvassori L, Boccardi E, Scialfa G (2006) Treatment of a middle cerebral artery giant aneurysm using a covered stent. Case report. J Neurosurg 104:965–968
Schubiger O, Valavanis A, Hayek J (1980) Computed tomography in cerebral aneurysms with special emphasis on giant intracranial aneurysms. J Comput Assist Tomogr 4:24–32
Schubiger O, Valavanis A, Wichmann W (1987) Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology 29:266–271
Steinberg GK, Drake CG, Peerless SJ (1993) Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg 79:161–173
Terada T, Tsuura M, Matsumoto H, Masuo O, Tsumoto T, Yamaga H, Itakura T (2005) Endovascular treatment of unruptured cerebral aneurysms. Acta Neurochir Suppl 94:87–91
Zhao L, Moos MP, Grabner R, Pedrono F, Fan J, Kaiser B, John N, Schmidt S, Spanbroek R, Lotzer K, Huang L, Cui J, Rader DJ, Evans JF, Habenicht AJ, Funk CD (2004) The 5-lipoxygenase pathway promotes pathogenesis of hyperlipidemia-dependent aortic aneurysm. Nat Med 10:966–973
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Dehdashti, A.R., Thines, L., Willinsky, R.A. et al. Symptomatic enlargement of an occluded giant carotido-ophthalmic aneurysm after endovascular treatment: the vasa vasorum theory. Acta Neurochir 151, 1153–1158 (2009). https://doi.org/10.1007/s00701-009-0270-0
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DOI: https://doi.org/10.1007/s00701-009-0270-0