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A 10-year follow-up of extracranial–intracranial bypass for the treatment of bilateral giant internal carotid artery aneurysms in a patient with fibromuscular dysplasia: case report

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Abstract

Cervicocephalic fibromuscular dysplasia (FMD) is an idiopathic, non-inflammatory and non-atherosclerotic arteriopathy which usually affects small- and medium-sized cervical arteries distributed at the atlas and axis interspace. Few cervicocephalic FMD patients are associated with multiple intracranial aneurysms which may rupture or develop. So the authors describe a cervicocephalic FMD patient with a history of right oculomotor palsy in 2000. Angiography revealed bilateral internal carotid artery (ICA) aneurysms and a fusiform aneurysm in right vertebral artery. Typical “string-of-beads” phenomenon was observed in V2 segment of left vertebral artery. The right ICA giant aneurysm was treated by right ICA occlusion and superficial temporal artery (STA)-middle cerebral artery (MCA) bypass at that time. Five years later, the patient presented with paroxysmal weakness in right limbs. The subsequent angiography showed the enlargement of left ICA aneurysm. It was treated satisfactorily with left external carotid artery-saphenous vein-MCA bypass and left ICA ligation. During the long-term follow-up, the patient kept no neurological deficit and the angiography showed good patency of bilateral grafts and the lesions in bilateral vertebral arteries remained unchanged.

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Authors and Affiliations

  1. Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, No. 45 Chang Chun Street, Xuan Wu district, Beijing, 100053, China

    Yan Ma, Meng Li, Hongqi Zhang & Feng Ling

Authors
  1. Yan Ma
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  2. Meng Li
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  3. Hongqi Zhang
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  4. Feng Ling
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Correspondence to Feng Ling.

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Comment

So far, we do not know enough about the pathobiology of arterial or aneurysm wall, and therefore the ultimate etiology of most vascular lesions remains to be defined. Naturally, hemodynamics play an important role but despite modern imaging combined even with complicated mathematical models we still can not precisely predict what will happen to a single aneurysm, whether it will grow or rupture or not and what is the time-span. With surgery and endovasular techniques we may change the flow-dynamics and affect the already diseased parent or adjacent arteries. This well-written case report demonstrates very well the necessity of follow-up of neurovascular patients, especially those with a predisposing condition, as with long-term follow-up after seemingly curative treatment one may experience surprises. Accurate diagnostics, and when needed, multimodality treatment in dedicated neurovascular centers are beneficial for the patients.

Mika Niemelä

Juha Hernesniemi

Helsinki, Finland

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Ma, Y., Li, M., Zhang, H. et al. A 10-year follow-up of extracranial–intracranial bypass for the treatment of bilateral giant internal carotid artery aneurysms in a patient with fibromuscular dysplasia: case report. Acta Neurochir 152, 2191–2195 (2010). https://doi.org/10.1007/s00701-010-0778-3

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  • DOI: https://doi.org/10.1007/s00701-010-0778-3

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