Spontaneous thrombosis of giant intracranial aneurysm and posterior cerebral artery followed by also spontaneous recanalization

Aguiar, Guilherme Brasileiro de; Pagotto, Mário Vítor Caldeira; Conti, Mário Luiz Marques; Veiga, José Carlos Esteves

doi:10.4103/2152-7806.175898

Cited by 16 publications

(10 citation statements)

References 22 publications

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“…Focal arterial stenotic segments are often observed proximal or distal to the dissecting aneurysm, suggesting mural damage, as seen in some cases in this series. The impaired vessel wall and associated stenosis can induce spontaneous thrombosis [1, 16], but when treated, the treatment of these aneurysms must also target the mass effect [7].…”

Section: Discussionmentioning

confidence: 99%

Intracranial Aneurysm in Pediatric Population: A Single-Center Experience

et al. 2022

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Purpose: Pediatric intracranial aneurysms (PIA) are rarer and more complex when compared to adult aneurysms. In general, the clinical presentation of PIA is due to a mass effect, but the presenting symptoms can be also related to ischemia, subarachnoid hemorrhage (SAH) or in a combination of different symptoms. This paper aims to report a single-center experience with clinical and angiographic aspects of brain aneurysm in children. Methods: We retrospectively reviewed our prospectively maintained database for patients with intracranial aneurysms in our institution from July 2015 to February 2021. Among these, all patients under 18 years-old submitted to a diagnostic or therapeutic procedure for an intracranial aneurysm were included. Results: Twelve patients were submitted to diagnostic or therapeutic procedures in our department. Three of them had multiple aneurysms, and in total, 17 intracranial aneurysms were assessed in this study. The most frequent location was in the middle cerebral artery (seven cases / 41%). Five out of twelve children (42%) presented SAH due to ruptured aneurysm. Three patients (25%) had symptoms due to the mass effect from large aneurysms, with compression of cranial nerves or brainstem. Aneurysms diameters ranged from 1.5 mm to 34 mm (mean 14.2 mm), with six aneurysms being giant and eight being non-saccular/fusiform. Twelve aneurysms were submitted to endovascular treatment, with one treatment-related clinical complication and later death. Conclusion: Pediatric intracranial aneurysms are rare diseases that can arise from a variety of different underlying pathological mechanisms. The management of these conditions requires a detailed understanding of the pathology and a multi-disciplinary approach. Despite the availability of new technologies, parent vessel occlusion remains a valid option for aneurysms in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Intracranial Aneurysm in Pediatric Population: A Single-Center Experience

et al. 2022

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“…It is important to take into account the course of thrombosed intracranial aneurysms in association with simultaneous ICA occlusion to construct an effective management plan. Aneurysmal thrombosis may not be the end of the story; with further aneurysmal growth, persistent mass effect, distal thrombo-embolism, and aneurysmal re-canalization being all potential occurrences even with fully thrombosed aneurysms, as long as the parent vessel is patent [ 9 , 10 , 22 , 24 , 25 ]. However, the co-existent thrombosis and hence non-patency of the parent vessel raises the question if recanalization of the thrombosed aneurysm can occur.…”

Section: Discussionmentioning

confidence: 99%

“…However, the co-existent thrombosis and hence non-patency of the parent vessel raises the question if recanalization of the thrombosed aneurysm can occur. Even though the chances are extremely narrow, it is possible and has been reported in a case of a thrombosed PCA aneurysm with parent vessel occlusion followed by recanalization of the aneurysmal neck and PCA several years later [ 10 ]. To date, of all the reported cases of thrombosed CCA aneurysms with ICA occlusion, no recanalization has been reported [ 11 - 22 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous thrombosis of a giant cavernous-carotid aneurysm with simultaneous ipsilateral complete parent artery occlusion: a rare phenomenon and review of the literature

Abousedu¹,

Saleem²,

Alenezi³

et al. 2023

Arch Clin Cases

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Cavernous-carotid artery (CCA) aneurysms represent about 3-5% of all intracranial aneurysms. Spontaneous thrombosis of a CCA aneurysm with simultaneous occlusion of its parent vessel is an extremely rare phenomenon with few reported cases in the literature offering different management strategies. A 54-year-old Asian female presented with a one day-history of painless left eye conjunctival injection, proptosis, and features of cavernous sinus syndrome (cranial nerve III, IV, V1, V2, and VI palsies). Imaging revealed a giant thrombosed CCA aneurysm measuring 3.6cmx3.4cm with complete thrombosis of the left cervical internal carotid artery (ICA) and adequate collaterals from the anterior and posterior communicating artery and branches of the left external carotid artery. Management was conservative with antiplatelet therapy and close clinical-radiological follow-ups. The outcome was satisfactory. Data in the literature on this condition is limited due to its exceedingly rare occurrence. The majority of patients do well via a conservative approach and surgery is rarely indicated. For clinically stable patients, especially those with adequate collateral circulation and tolerance to Balloon Test Occlusion, we advocate for a conservative approach and initiation of anti-platelet therapy to treat these patients. Emphasis is needed on close serial clinicalradiological surveillance in these cases to monitor the propagation of the thrombus as well as the development of new and/or enlarging pre-existing aneurysms in the contralateral ICA circulation.

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“…Previous studies have reported rare cases of completely thrombosed aneurysms that presented with recanalization, reenlargement, and ischemic events. [10][11][12] Therefore, craniotomy or endovascular treatment should be considered along with a follow-up, and the resection performed in this case is considered reasonable.…”

Section: Discussionmentioning

confidence: 99%

A complete thrombotic large aneurysm at the nonbranching segment of the distal anterior cerebral artery mimicking a cavernous malformation: illustrative case

Hirokawa

Michiwaki

Tanaka

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Thrombotic aneurysms at the nonbranching segment of the distal anterior cerebral artery (ACA) are extremely rare and difficult to differentiate from cavernous malformations by radiographic features alone. OBSERVATIONS Computed tomography and magnetic resonance imaging of a 30-year-old female patient with a chronic headache complaint revealed a 22-mm frontal lobe mass. The mass showed heterogeneous mixed intensity and hemosiderin deposits on magnetic resonance images. It was not visualized by conventional angiography, indicating that the mass and ACA/other vessels were not connected. The patient was preoperatively diagnosed with a cavernous malformation. However, during resection, the mass surface was white and smooth, different from a cavernous malformation. Although the mass was adherent to the pericallosal artery branch, no luminal continuity was observed. After detachment, the mass was completely resected. Pathological and immunohistochemical findings indicated a vessel wall and interior thrombus. The patient was rediagnosed with a thrombotic aneurysm at the distal ACA nonbranching segment and discharged 10 days postsurgery without neurological deficits. LESSONS Because radiographic findings of thrombotic aneurysm and cavernous malformation are similar, mass lesions in contact with major arteries should be differentiated as thrombotic aneurysms, even when the artery lumen appears disconnected from the mass.

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Spontaneous thrombosis of giant intracranial aneurysm and posterior cerebral artery followed by also spontaneous recanalization

Cited by 16 publications

References 22 publications

Intracranial Aneurysm in Pediatric Population: A Single-Center Experience

Intracranial Aneurysm in Pediatric Population: A Single-Center Experience

Spontaneous thrombosis of a giant cavernous-carotid aneurysm with simultaneous ipsilateral complete parent artery occlusion: a rare phenomenon and review of the literature

A complete thrombotic large aneurysm at the nonbranching segment of the distal anterior cerebral artery mimicking a cavernous malformation: illustrative case

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