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Minim Invasive Neurosurg 2009; 52(1): 39-43
DOI: 10.1055/s-0028-1104565
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Visual Worsening after Incomplete Coiling of a Small Asymptomatic Aneurysm: Case Report and Review of the Literature

M. Killer 1 , G. Baltsavias 2 , M. Huemer 3 , B. Richling 4
  • 1Department of Neurology/Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
  • 2Department of Neurosurgery, Interbalkan Medical Center, Thessalonica, Greece
  • 3Department of Neurology, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Austria
  • 4Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
Further Information

Publication History

Publication Date:
26 February 2009 (online)

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Abstract

Objective: Complications with increased mass effect on surrounding structures have as yet only been noted after coiling of large, giant, and thrombosed aneurysms. We describe a case of optic chiasm compression after incomplete coil embolization of a small ICA aneurysm and discuss the potential mechanisms causing this phenomenon.

Case Report: A 57-year-old male presented with an incidental, 7-mm diameter, C2 segment, ICA aneurysm. Endovascular intervention with platinum coils resulted in 80% obliteration. Approximately three weeks later the patient developed visual changes which progressed over 10 days to a homonymous hemianopsia with a central scotoma. A pterional craniotomy was performed to decompress and to definitively clip the aneurysm. Histological evaluation of the aneurysm showed sinusoidal vessels, filled with proliferated endothelial cells and being encapsulated by fibrous tissue, suspicious for exposure to systemic blood pressure.

Conclusion: Even small aneurysms undergoing incomplete coil embolization may affect surrounding, eloquent neural structures due to unexpected tissue formation in the aneurysm.

Key words

aneurysm - endovascular coiling - mass effect - decompression

References

  • 1 Hacein-Bey L, Connolly Jr ES, Mayer SA. et al . Complex intracranial aneurysms: combined operative and endovascular approaches.  Neurosurgery. 1998;  43 1304-1312 , discussion 1312–1303
    PubMedGoogle Scholar
  • 2 Russell SM, Nelson PK, Jafar JJ. Neurological deterioration after coil embolization of a giant basilar apex aneurysm with resolution following parent artery clip ligation. Case report and review of the literature.  J Neurosurg. 2002;  97 705-708
    PubMedGoogle Scholar
  • 3 Thornton J, Dovey Z, Alazzaz A. et al . Surgery following endovascular coiling of intracranial aneurysms.  Surgical Neurol. 2000;  54 352-360
    CrossrefPubMedGoogle Scholar
  • 4 Mitha AP, Wong JH, Lu JQ. et al . Communicating hydrocephalus after endovascular coiling of unruptured aneurysms: report of 2 cases.  J Neurosurg. 2008;  108 1241-1244
    PubMedGoogle Scholar
  • 5 Meyers PM, Lavine SD, Fitzsimmons BF. et al . Chemical meningitis after cerebral aneurysm treatment using two second-generation aneurysm coils: report of two cases.  Neurosurgery. 2004;  55 1222
    CrossrefPubMedGoogle Scholar
  • 6 Berenstein A, Song JK, Niimi Y. et al . Treatment of cerebral aneurysms with hydrogel-coated platinum coils (HydroCoil): early single-center experience.  AJNR Am J Neuroradiol. 2006;  27 1834-1840
    PubMedGoogle Scholar
  • 7 Arthur AS, Wilson SA, Dixit S. et al . Hydrogel-coated coils for the treatment of cerebral aneurysms: preliminary results.  Neurosurg Focus. 2005;  18 E1
    PubMedGoogle Scholar
  • 8 Strother CM, Eldevik P, Kikuchi Y. et al . Thrombus formation and structure and the evolution of mass effect in intracranial aneurysms treated by balloon embolization: emphasis on MR findings.  AJNR Am J Neuroradiol. 1989;  10 787-796
    PubMedGoogle Scholar
  • 9 Tsuura M, Terada T, Nakamura Y. et al . Magnetic resonance signal intensity and volume changes after endovascular treatment of intracranial aneurysms causing mass effect.  Neuroradiology. 1998;  40 184-188
    CrossrefPubMedGoogle Scholar
  • 10 Halbach VV, Higashida RT, Dowd CF. et al . The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect.  J Neurosurg. 1994;  80 659-666
    CrossrefPubMedGoogle Scholar
  • 11 Malisch TW, Guglielmi G, Vinuela F. et al . Unruptured aneurysms presenting with mass effect symptoms: response to endosaccular treatment with Guglielmi detachable coils. Part I. Symptoms of cranial nerve dysfunction.  J Neurosurg. 1998;  89 956-961
    PubMedGoogle Scholar
  • 12 Litofsky NS, Vinuela F, Giannotta SL. Progressive visual loss after electrothrombosis treatment of a giant intracranial aneurysm: case report.  Neurosurgery. 1994;  34 548-550 , discussion 551
    CrossrefPubMedGoogle Scholar
  • 13 Kwan ES, Heilman CB, Shucart WA. et al . Enlargement of basilar artery aneurysms following balloon occlusion – “water-hammer effect” Report of two cases.  J Neurosurg. 1991;  75 963-968
    PubMedGoogle Scholar
  • 14 Crompton MR. Mechanism of growth and rupture in cerebral berry aneurysms.  Brit Med J. 1966;  1 1138-1142
    PubMedGoogle Scholar
  • 15 Firat MM, Cekirge S, Saatci I. et al . Guglielmi detachable coil treatment of a partially thrombosed giant basilar artery aneurysm in a child.  Neuroradiology. 2000;  42 142-144
    CrossrefPubMedGoogle Scholar
  • 16 Batjer HH, Purdy PD. Enlarging thrombosed aneurysm of the distal basilar artery.  Neurosurgery. 1990;  26 695-699 , discussion 699–700
    PubMedGoogle Scholar
  • 17 Whittle IR, Dorsch NW, Besser M. Spontaneous thrombosis in giant intracranial aneurysms.  J Neurol Neurosurg Psychiatry. 1982;  45 1040-1047
    PubMedGoogle Scholar
  • 18 Nakatomi H, Segawa H, Kurata A. et al . Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth.  Stroke; a J Cerebr Circul. 2000;  31 896-900
    PubMedGoogle Scholar
  • 19 Oka H, Kurata A, Miyasaka Y. et al . Completely thrombosed large aneurysm of the distal middle cerebral artery: a case report.  No shinkei geka. 1994;  22 677-680
    PubMedGoogle Scholar
  • 20 Griffiths PD, Gholkar A, Sengupta RP. Oculomotor nerve palsy due to thrombosis of a posterior communicating artery aneurysm following diagnostic angiography.  Neuroradiology. 1994;  36 614-615
    CrossrefPubMedGoogle Scholar
  • 21 Heros RC, Kolluri S. Giant intracranial aneurysms presenting with massive cerebral edema.  Neurosurgery. 1984;  15 572-577
    PubMedGoogle Scholar
  • 22 Ushikoshi S, Kikuchi Y, Houkin K. et al . Aggravation of brainstem symptoms caused by a large superior cerebellar artery aneurysm after embolization by Guglielmi detachable coils – case report.  Neurologia medico-chirurgica. 1999;  39 524-529
    PubMedGoogle Scholar
  • 23 Pozzati E, Nuzzo G, Gaist G. Giant aneurysm of the pericallosal artery. case report.  J Neurosurg. 1982;  57 566-569
    PubMedGoogle Scholar
  • 24 Merei FT, Gallyas F. Role of the structural elements of the arterial wall in the formation and growth of intracranial saccular aneurysms.  Neurological Res. 1980;  2 283-303
    PubMedGoogle Scholar
  • 25 Sekhar LN, Heros RC. Origin, growth, and rupture of saccular aneurysms: a review.  Neurosurgery. 1981;  8 248-260
    PubMedGoogle Scholar
  • 26 Suzuki J, Ohara H. Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth.  J Neurosurg. 1978;  48 505-514
    PubMedGoogle Scholar
  • 27 Yong-Zhong G, Alphen HA van. Pathogenesis and histopathology of saccular aneurysms: review of the literature.  Neurological Res. 1990;  12 249-255
    PubMedGoogle Scholar
  • 28 Foutrakis GN, Yonas H, Sclabassi RJ. Saccular aneurysm formation in curved and bifurcating arteries.  AJNR. 1999;  20 1309-1317
    PubMedGoogle Scholar
  • 29 Ortiz O, Voelker J, Eneorji F. Transient enlargement of an intracranial aneurysm during pregnancy: case report.  Surgical Neurol. 1997;  47 527-531
    PubMedGoogle Scholar
  • 30 Kosierkiewicz TA, Factor SM, Dickson DW. Immunocytochemical studies of atherosclerotic lesions of cerebral berry aneurysms.  J Neuropathol Experimtl Neurol. 1994;  53 399-406
    PubMedGoogle Scholar
  • 31 Katayama Y, Tsubokawa T, Miyazaki S. et al . Growth of totally thrombosed giant aneurysm within the posterior cranial fossa. Diagnostic and therapeutic considerations.  Neuroradiology. 1991;  33 168-170
    CrossrefPubMedGoogle Scholar
  • 32 Schubiger O, Valavanis A, Wichmann W. Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging.  Neuroradiology. 1987;  29 266-271
    CrossrefPubMedGoogle Scholar
  • 33 Nagahiro S, Takada A, Goto S. et al . Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management.  J Neurosurg. 1995;  82 796-801
    PubMedGoogle Scholar
  • 34 Maruishi M, Shima K, Chigasaki H. et al . Giant intracranial aneurysm with rapid thrombus formation and intramural hemorrhage – case report.  Neurologia medico-chirurgica. 1994;  34 829-831
    PubMedGoogle Scholar
  • 35 Skirgaudas M, Awad IA, Kim J. et al . Expression of angiogenesis factors and selected vascular wall matrix proteins in intracranial saccular aneurysms.  Neurosurgery. 1996;  39 537-545 , discussion 545–537
    CrossrefPubMedGoogle Scholar

Correspondence

M. KillerMD 

Department of Neurology/Neuroscience Institute

Christian Doppler Clinic

Paracelsus Medical University

Ignaz-Harrer Straße 79

5020 Salzburg

Austria

Phone: +43/662/4483 560 58

Fax: +43/662/4483 30 04

Email: m.killer@salk.at