Completely Thrombosed Giant Intracranial Aneurysm with Spontaneous Thrombosis of the Parent Artery: Is It Nature's Divine Intervention and a Self-Cure?

Das, Kuntal Kanti; Singh, Gagandeep; Pandey, Satya Deo; Bhaisora, Kamlesh Singh; Jaiswal, Awadhesh Kumar; Behari, Sanjay

doi:10.1016/j.wneu.2018.07.072

Cited by 25 publications

(49 citation statements)

References 15 publications

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Section: Discussionmentioning

confidence: 99%

“…Complete intraluminal thrombosis is uncommon and occurs especially in large and giant cerebral aneurysms in 13–20% of cases [4]. This phenomenon is explained by endothelial damage due to hemodynamic stress on the aneurysmal wall [4]. CT characteristics of thrombosed IAs are peripheral ring enhancement, curvilinear mural calcification, intraluminal mixed high-density calcification and the presence of “target sign” [8].…”

Section: Discussionmentioning

confidence: 99%

“…Based on this MRI feature and on the intraoperative fact that the parent vessel was probably coming from the left ACA, spontaneous occlusion of the parent artery (left A2-segment) harboring the GIA was suspected. Indeed, although this scenario is extremely rare, [4] it would probably explain the absence of intraluminal flow void and absence of enhancement of the aneurysmal parent vessel on both TOF- and TWIST-MRI. In fact, the mechanism of the spontaneous thrombosis of an aneurysm and its parent artery is not known [4].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, although this scenario is extremely rare, [4] it would probably explain the absence of intraluminal flow void and absence of enhancement of the aneurysmal parent vessel on both TOF- and TWIST-MRI. In fact, the mechanism of the spontaneous thrombosis of an aneurysm and its parent artery is not known [4]. Theories of local stretching, compression and distortion of the ICA could explain the occurrence of this complication in IAs of the cavernous segment, due to the presence of dural folds and bony structures at this location [10].…”

Section: Discussionmentioning

confidence: 99%

“…They typically become symptomatic between the 4th and the 7th decade, with a female to male ratio ranging from 1:1 to 3:1 [2]. The incidence of intraluminal thrombosis ranges from 10 to 30% of the cases, [3] however, a complete aneurysmal thrombosis is extremely rare [4]. The majority of these aneurysms are located in the internal carotid artery (ICA) and in the middle cerebral artery (MCA), the anterior cerebral artery (ACA) being an exceptional location [1].…”

Section: Introductionmentioning

confidence: 99%

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A rare case of a completely thrombosed bilobed giant intracranial aneurysm of the anterior cerebral artery with spontaneous parent vessel thrombosis: case report

et al. 2019

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BackgroundA huge spherical intracranial mass can sometimes be misdiagnosed, due to the lack of typical radiographic features. Thrombosed giant intracranial aneurysms (GIAs) are an uncommon but still a possible differential diagnosis that must be kept in mind to guarantee the best surgical approach and resection of the lesion. We describe an extremely rare case of a huge bifrontal mass mimicking a cystic echinococcosis, in which the surgery unveiled a completely thrombosed GIA of the left anterior cerebral artery (ACA).Case presentationA 61-year-old patient complained about intermittent weakness of the right leg, mild holocephalic headache, beginning cognitive deficits and lethargy. Magnetic resonance imaging (MRI) showed a huge partially calcified and bilobed frontal mass with peripheral edema. Based on a time-resolved angiography with interleaved Stochastic trajectories MRI (TWIST-MRI), a vascular origin of the lesion was considered unlikely. Therefore, the surgery was performed under the suspicion of a cystic echinococcosis but revealed a bilobed GIA of the left ACA with a parent vessel thrombosis. Although only a limited left frontal craniotomy was performed, a proximal control of the parent vessel could be ensured, and the aneurysm was successfully clipped. The patient showed postoperatively no new neurological deficits.ConclusionsCompletely thrombosed GIAs with parent vessel thrombosis are rare lesions that might be misdiagnosed if typical radiographic features are missing. Thus, in case of an intracranial spherical mass with signs of intralesional hemorrhage and mural calcifications, presence of a completely thrombosed GIA should be considered as a possible differential diagnosis.

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Section: Discussionmentioning

confidence: 99%