gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Spontaneous disappearance of one aneurysm in a patient with bilateral paraopthalmic giant aneurysms

Spontane Resorption eines von beidseitigen Riesenaneurysmen im Paraophthalmicabereich

Meeting Abstract

  • corresponding author S.-U. Pauli - Klinik für Neurochirurgie, Otto-von-Guericke-Universität, Magdeburg
  • H. J. Synowitz - Klinik für Neurochirurgie, Otto-von-Guericke-Universität, Magdeburg
  • M. Skalej - Klinik für Radiologie, Abtl. Neuroradiologie, Otto-von-Guericke Universität, Magdeburg
  • R. Firsching - Klinik für Neurochirurgie, Otto-von-Guericke-Universität, Magdeburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP068

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0336.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Pauli et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

The treatment of giant aneurysm is both a neurosurgical problem and a technical challenge as evidenced by the variety and complexity of surgical strategies. Current treatment options of obliterating the aneurysm, maintaining adequate cerebral blood flow relieving mass effect includes hunterian ligation, proximal endovascular occlusion, trapping with or without a bypass graft, endovascular coiling or direct surgical repair with vessel reconstruction.

Methods

Bilateral paraophtalmic aneurysms occurred in 29-year-old women with a mild congenital impairment of intelligence. The women suffered a short unconciousness, confusion and four days later headache and oculomotor palsy on the right side. The MRI/MRA showed a 30mm aneurysm with flow void in the parasellar space on the left, contralateral a 40mm aneurysm without signs of blood flow. The angiogram showed the aneurysm left side, obliteration of the whole ICA right near the bifurcation, the right hemisphere is only supplied from left via the ACoA. The left VA show only a small PcoA. In the discussion of the definitive treatment an endovascular approach was preferred. An EC/IC Bypass was performed on the left side to avoid cerebral ischemia due to the collateral supply origin from this side.

Results

The clinical status 4 month later showed a complete recovery of the oculomotor palsy. The MRI couldn’t detect the pre-existing giant aneurysm on the right side. The angiogram showed a little increase of the left aneurysm, the obliterated ICA right. The EC/IC anatomises showed no explicit contrast of the peripheral branches of the left MCA at the present flow characteristics.

Conclusions

Neurological deficits may occur due to the increase of the giant aneurysm by partial thrombosis or intramural haemorrhage. (Yasui et al 1993).The onset of the oculomotor palsy could be explained with complete thrombosis of the aneurysm and the simultaneous obliteration of the ICA. According to performing an EC/IC mikroanastomosis hemodynamic alteration could induce spontaneous thrombosis of giant aneurysm or sometimes a consecutive rupture of it. In any cases the ipsilateral side was afflicted. (Cantore et al 1999) In our case the EC/IC- bypass was performed on the left side but the aneurysm on the contralateral side spontaneous disappeared. Only one case is referred with a spontaneous disappearance of a giant aneurysm. (Krapf et al 2002)