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Seven Intracranial Aneurysms in One Patient: Treatment and Review of Literature.

Ahmed O, Kalakoti P, Hefner M, Cuellar H, Guthikonda B - J Cerebrovasc Endovasc Neurosurg (2015)

Bottom Line: Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure.Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery).The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

ABSTRACT
Before the advent of endovascular coiling, patients with multiple intracranial aneurysms were treated with surgical clipping; however, with the advancements in endovascular technology, intracranial aneurysms can be treated with surgical clipping and/or endovascular coiling. We describe a case of subarachnoid hemorrhage in a patient with 7 intracranial aneurysms. A 45-year-old female developed a sudden headache and left sided hemiparesis. Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure. Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery). The patient underwent two craniotomies for surgical clipping of the anterior circulation aneurysms and endovascular stent-assisted coils for the posterior circulation aneurysms. The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy. We describe a case report and decision making for a patient with multiple intracranial aneurysms treated with surgical clipping and endovascular coiling.

No MeSH data available.


Related in: MedlinePlus

Angiogram showing obliteration of the left posterior communicating, left middle cerebral, and anterior communicating artery aneurysms.
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Figure 9: Angiogram showing obliteration of the left posterior communicating, left middle cerebral, and anterior communicating artery aneurysms.

Mentions: Considering the extraordinary number of intracranial aneurysms seen in our patient, a multidisciplinary approach to management of these aneurysms was considered. After consultation with the neurointerventionalist, it was determined that a stent-assisted coil would be required for endovascular treatment of the MCA aneurysms and the SCA aneurysm. Because of the risk of complications with endovascular treatment of MCA aneurysms, we elected to clip the ruptured aneurysm and the remaining anterior circulation aneurysms. The patient underwent a right pterional craniotomy for microsurgical clipping of the two MCA aneurysms on the right side. Two months later, the patient underwent a left pterional craniotomy for clipping of the left MCA artery aneurysm, left PCOM aneurysm, and the ACOM aneurysm (Fig. 9). Finally, the patient underwent stent assisted coil embolization of the left SCA aneurysm and coil embolization of the right PICA aneurysm two months later (Fig. 10).


Seven Intracranial Aneurysms in One Patient: Treatment and Review of Literature.

Ahmed O, Kalakoti P, Hefner M, Cuellar H, Guthikonda B - J Cerebrovasc Endovasc Neurosurg (2015)

Angiogram showing obliteration of the left posterior communicating, left middle cerebral, and anterior communicating artery aneurysms.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495085&req=5

Figure 9: Angiogram showing obliteration of the left posterior communicating, left middle cerebral, and anterior communicating artery aneurysms.
Mentions: Considering the extraordinary number of intracranial aneurysms seen in our patient, a multidisciplinary approach to management of these aneurysms was considered. After consultation with the neurointerventionalist, it was determined that a stent-assisted coil would be required for endovascular treatment of the MCA aneurysms and the SCA aneurysm. Because of the risk of complications with endovascular treatment of MCA aneurysms, we elected to clip the ruptured aneurysm and the remaining anterior circulation aneurysms. The patient underwent a right pterional craniotomy for microsurgical clipping of the two MCA aneurysms on the right side. Two months later, the patient underwent a left pterional craniotomy for clipping of the left MCA artery aneurysm, left PCOM aneurysm, and the ACOM aneurysm (Fig. 9). Finally, the patient underwent stent assisted coil embolization of the left SCA aneurysm and coil embolization of the right PICA aneurysm two months later (Fig. 10).

Bottom Line: Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure.Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery).The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

ABSTRACT
Before the advent of endovascular coiling, patients with multiple intracranial aneurysms were treated with surgical clipping; however, with the advancements in endovascular technology, intracranial aneurysms can be treated with surgical clipping and/or endovascular coiling. We describe a case of subarachnoid hemorrhage in a patient with 7 intracranial aneurysms. A 45-year-old female developed a sudden headache and left sided hemiparesis. Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure. Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery). The patient underwent two craniotomies for surgical clipping of the anterior circulation aneurysms and endovascular stent-assisted coils for the posterior circulation aneurysms. The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy. We describe a case report and decision making for a patient with multiple intracranial aneurysms treated with surgical clipping and endovascular coiling.

No MeSH data available.


Related in: MedlinePlus