Abstract
Aneurysms of the supraclinoid carotid segment are frequently occurring lesions. Growth and/or rupture may eventually lead to ophthalmoplegia and subarachnoid hemorrhage (SAH). Avoiding cranial nerve palsy and an SAH are the primary goals of treatment. In the past decade, new techniques involving endoluminal vessel reconstruction by flow diverters have become available and currently present an encouraging treatment alternative to surgery, coil embolization, or deconstructive parent vessel occlusion. Present data showing reliable aneurysm occlusion with low complication rates has led to a paradigm shift in managing these lesions. A female patient presenting with an incidental supraclinoid ICA aneurysm was treated with a p64 flow diverter. Prior to this treatment, the endovascular procedure was simulated using a 1:1 3D-printed endoluminal aneurysm model in order to investigate the optimal size and expected deployment behavior of the flow diverter to be used. Stereolithography was used to manufacture the vascular model to a high degree of precision from 3D rotational DSA image data. A flow diverter was then deployed in a 3D model, and the patient was treated accordingly. Post procedural angiography showed immediate hemostasis within the aneurysm and the follow-up DSA at six months showed complete occlusion of the supraclinoid aneurysm.
References
Aguilar Pérez M, Bhogal P, Martinez Moreno R, Bäzner H, Ganslandt O, Henkes H. The Medina Embolic Device: early clinical experience from a single center. J Neurointerv Surg. 2017;9(1):77–87. https://doi.org/10.1136/neurintsurg-2016-012539.
Becske T, Brinjikji W, Potts MB, Kallmes DF, Shapiro M, Moran CJ, Levy EI, McDougall CG, Szikora I, Lanzino G, Woo HH, Lopes DK, Siddiqui AH, Albuquerque FC, Fiorella DJ, Saatci I, Cekirge SH, Berez AL, Cher DJ, Berentei Z, Marosfoi M, Nelson PK. Long-term clinical and angiographic outcomes following Pipeline Embolization Device treatment of complex internal carotid artery aneurysms: five-year results of the Pipeline for Uncoilable or Failed Aneurysms Trial. Neurosurgery. 2017;80(1):40–8. https://doi.org/10.1093/neuros/nyw014.
Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology. 1998;206(2):499–510.
Frölich AM, Spallek J, Brehmer L, Buhk JH, Krause D, Fiehler J, Kemmling A. 3D printing of intracranial aneurysms using fused deposition modeling offers highly accurate replications. AJNR Am J Neuroradiol. 2016;37(1):120–4. https://doi.org/10.3174/ajnr.A4486.
Gurkas E, Kaya T, Daglioglu E, Akmangit I, Belen D, Peker A, Dede D, Arat A. Silk device for the treatment of intracranial aneurysms. Part 1: peri-procedural results, technical aspects and learning curve. Turk Neurosurg. 2016;26(4):525–32. https://doi.org/10.5137/1019-5149.JTN.14759-15.0.
Henkes H, Bose A, Felber S, Miloslavski E, Berg-Dammer E, Kühne D. Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (Neuroform). Interv Neuroradiol. 2002;8(2):107–19.
Jing L, Zhong J, Liu J, Yang X, Paliwal N, Meng H, Wang S, Zhang Y. Hemodynamic effect of flow diverter and coils in treatment of large and giant intracranial aneurysms. World Neurosurg. 2016;89:199–207. https://doi.org/10.1016/j.wneu.2016.01.079.
Moret J, Cognard C, Weill A, Castaings L, Rey A. The “Remodelling Technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol. 1997;3(1):21–35.
O’Shaughnessy BA, Getch CC, Bendok BR, Batjer HH. Surgical management of unruptured posterior carotid artery wall aneurysms. Neurosurg Focus. 2003;15(1):E9.
Shekhtman OD, Eliava SS, Yakovlev SB, Pilipenko YV, Konovalov AN. The modern role of microsurgery in treatment of large and giant aneurysms of the internal carotid artery. Zh Vopr Neirokhir Im N N Burdenko. 2016;80(5):51–61. https://doi.org/10.17116/neiro201680551-61.
Shin D, Park J. Unruptured supraclinoid internal carotid artery aneurysm surgery: superciliary keyhole approach versus pterional approach. J Korean Neurosurg Soc. 2012;52(4):306–11. https://doi.org/10.3340/jkns.2012.52.4.306.
Suzuki K, Suzuki R, Takigawa T, Shimizu N, Matsumoto Y, Fujii Y, Inoue Y, Sugiura Y, Hirata K, Tsuda K, Kawamura Y, Takano I, Nakae R, Nagaishi M, Tanaka Y, Hyodo A. A single center experience with coil embolization for cerebral aneurysms greater than 10 mm in the internal carotid artery. Neurol Med Chir (Tokyo). 2017;57(5):231–7. https://doi.org/10.2176/nmc.oa.2016-0176.
Wallace AN, Kayan Y, Austin MJ, Delgado Almandoz JE, Kamran M, Cross DT 3rd, Moran CJ, Osbun JW, Kansagra AP. Pipeline embolization of posterior communicating artery aneurysms associated with a fetal origin posterior cerebral artery. Clin Neurol Neurosurg. 2017;160:83–7. https://doi.org/10.1016/j.clineuro.2017.06.014.
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Kemmling, A., Eckey, T., Schramm, P. (2018). Supraclinoid Internal Carotid Artery Aneurysm: Incidental Aneurysm, Flow Diverter Deployment Practicing in an 1:1 3D-printed Aneurysm Model, Complete Occlusion by Coil-Assisted p64 Flow Diversion. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_41-1
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