Case of endovascular treatment of a patient with fusiform aneurysm de novo m2-branch of the middle brain artery
A clinical case with the choice of an individual strategy and tactics of endovascular treatment of a patient with fusiform aneurysm de novo of a branch of the middle cerebral artery is considered. Diagnosis and treatment was carried out in Scientific-practical Center of endovascular neuroradiology of the National Academy of Medical Sciences of Ukraine. Patient B., born in 1996, was admitted to the center in the acute period of hemorrhage from the fusiform aneurysm of the M2-branch of the middle cerebral artery, which, in turn, was excluded from circulation deconstructive, without neurological deficit in the postoperative period. Three months after the first endovascular treatment the patient was re-admitted to the center with the clinical manifestations of spontaneous subarachnoid hemorrhage. According to multispiral computed tomography and selective cerebral angiography, a fusiform aneurysm de novo of M2-branch of the middle cerebral artery was found, which, in turn, was excluded from circulation deconstructive in two stages. The first attempt at endovascular treatment failed to achieve total fusiform aneurysm de novo occlusion using detachable coils, due to the high risk of intraoperative complications. Ten days after the first stage the patient was taken again. Non-standard technique using balloon-assisted adhesive composition made it possible to achieve complete deconstructive occlusion of fusiform aneurysm de novo from the blood stream and to avoid complications in the form of neurological deficit. The postoperative period proceeded without features. In satisfactory condition the patient discharged under the supervision of a neurologist at the place of residence. The patient underwent 4 control examinations in the form of selective cerebral angiography. Collateral blood flow to the branches of the middle cerebral artery is preserved.
Wolfe CDA, Giroud M, Kolomisnky-Rabas P et al. Variations in stroke incidence and survival in 3 areas of Europe. Stroke. 2000;31:2074-9. https://doi.org/10.1161/01.STR.31.9.2074
Vilenskij B.S. Insult [monografiya]. Sankt-Peterburg: Med. inform. Agentstvo; 1995. 287 р. (In Russian)
Guglielmi G, Vinuela F, Sepetka I et al. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg. 1991;75:1-7.
Krylov VV, ed. Hirurgiya anevrizm golovnogo mozga: v 3 t. Мoscow; 2011, vol. 1. p. 12-23. (In Russian)
Sacho RH, Saliou G, Kostynskyy A et al. Natural history and outcome after treatment of unruptured intradural fusiform aneurysms. Stroke. 2014 Nov;45(11):3251-6. doi: 10.1161/STROKEAHA.114.006292.
Moseley Yu et al., 1982, Dziewasa, Freund et al., 2003. http://www.lifesciencesite.com/lsj/life1106/055_B00035life110614_388_393.pdf
Graf CJ, Hamby WB. Report of a case of cerebral aneurysm in an adult developing apparently de novo. J Neurol Neurosurg Psychiatr. 1964;27:153-6.
Wermer MJH, van der Schaaf IC, Velthuis BR et al. Follow up screening after subarachnoid haemorrhage: frequency and determinants of new aneurysms and enlargement of existing aneurysms. Brain. 2005;128:2421-9. PMID: 16000333. DOI:10.1093/brain/awh587
David CA, Vishteh AG, Spetzler RF et al. Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg. 1999;91:396-401. PMID: 10470813. DOI: 10.3171/jns.1999.91.3.0396
van der Schaaf IC. New detected aneurysms on follow-up screening in patients with previously clipped intracranial aneurysms: comparison with DSA or CTA at the time of SAH. Stroke. 2005;36(8):1753-8. PMID: 16002762. DOI:10.1161/01.STR.0000173160.21182.3b
This work is licensed under a Creative Commons Attribution 4.0 International License.