Artikel
Treatment of a giant paraclinoid internal carotid artery aneurysm with partial clip ligation, followed by flow diverter implantation – case report and literature review
Die Behandlung eines Riesenaneurysma der Arteria carotis interna kombiniert mikrochirurgisch und endovaskulär
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Autoren
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Amer Haj
- Universitätsklinikum Regensburg, Regensburg, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: A 53-year-old female patient presented with progressive visual loss of her left eye due to an atrophy of the optic nerve.Computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) showed a giant paraclinoid aneurysm of the internal carotid artery (ICA) on the left hand side, approximately measuring 35 x 23 mm, with consecutive compression of the left optic nerve.
Methods: Parent artery occlusion without bypass surgery did not appear possible, given the poor collaterals to the left anterior circulation. Primary flow diversion alone was turned down for the known risk of aneurysm rupture. Stent- or flow diverter-assisted coiling would both have been technically feasible but would have failed to reduce instantaneously the compression of the optic pathway. After interdisciplinary contemplation of these options microsurgical partial clipping of the aneurysm was chosen with the expectation to reduce the mass effect of the aneurysm. A subsequent need to reconstruct the parent artery by endovascular means was anticipated. We planned the craniotomy for partial clipping in deep hypothermia with circulatory arrest.
Results: No new permanent focal neurological deficit had occurred. The subsequent endovascular treatment was tolerated without clinical issues.Control DSA confirmed complete occlusion of the aneurysm with reconstruction of the left ICA.
Conclusion: Each giant aneurysm presents its own unique characteristics and should be approached individually. Benefits are best weighed in a multidisciplinary discussion, after which we used a combination of microsurgical partial clipping and endovascular flow diversion. This staged treatment concept illustrates the potential benefit of joined efforts of vascular neurosurgeons and interventional neuroradiologists, depending on their skills, field of expertise, and preferences.
