Coil embolization of an intracranial aneurysm in an infant with tuberous sclerosis complex: A case report and literature review

Abstract

Background:Tuberous sclerosis (TS) is a multiorgan neurocutaneous syndrome. Vascular manifestations are often extracranial. There is a paucity of cases involving TS combined with intracranial aneurysms reported in the literature. As a result, treatment has not been well described.Case Description:We report the case of a 13-month-old female infant with a prior diagnosis of TS that was found to have new onset of left eye ptosis, anisocoria, and papillary mydriasis indicative of left third cranial nerve palsy. A magnetic resonance angiogram (MRA) of the brain revealed a left internal carotid artery (ICA) aneurysm. Endovascular embolization was determined to be the best option for treatment. After a successful balloon test occlusion with neuromonitoring, the left internal carotid artery was sacrificed via coil embolization.Conclusions:This is only the third case report of endovascular coil embolization of an intracranial aneurysm in an infant with TS. We report no complications during the procedure, and the patient was discharged with resolving left third cranial nerve palsy. Neither surgical nor endovascular outcomes have been well described in the literature. Follow-up on this patient will be useful for establishing protocols of treatment.

Stent-assisted Coil Embolization of Petrous ICA in a Teenager with Neurofibromatosis

“…Cohen et al reported on a petrous ICA pseudoaneurysm in bilateral fibromuscular dysplasia, treated with a self-expanding covered stent and achieved good post-operative vascular patency. 1) Yi et al 16) reported on a case involving an infant who presented with a petrous ICA aneurysm with tuberous sclerosis (TS) complex. They emphasized that symptomatic petrous ICA aneurysm with TS must be considered in treatment with surgical or endovascular management.…”

Upper limb revascularization with reversed vein graft and microvascular anastomoses after brachial artery aneurysm resection in a child with tuberous sclerosis

“…Associated abnormalities include retinal lesions and tumors, benign rhabdomyomas of the heart, lung cysts, benign tumors in the viscera, bone cysts, and aneurysms 4,5 . Vascular manifestations are often extracanial, but intracranial aneurysms have been described 6 . Our patient had a fast-growing aneurysm that compromised both left axillary and brachial arteries and carried a moderate-to-high risk of rupture.…”

“…Nevertheless, such patients must be followed until adolescence, in order to look for limb-length discrepancies due to decreased limb growth 1 . Additionally, tuberous sclerosis is a condition that predisposes to other aneurysm formations 6 .…”

<p>Neuro-ophthalmological manifestations of tuberous sclerosis: current perspectives</p>

“…A cranial nerve III palsy in TSC is most concerning for an intracranial aneurysm. Although rare, cranial nerve III palsies due to aneurysms have been reported in both children and adults with TSC 40,41. A complete cranial nerve III palsy usually presents acutely with severe ipsilateral ptosis, mydriasis, and a hypotropic/abducted eye (ie, the eye is “down and out”) 42.…”