Study and Therapeutic Progress on Intracranial Serpentine Aneurysms

Abstract

An intracranial serpentine aneurysm (SA) is a clinically rare entity, and very few multi-case studies on SA have been published. The present study reviewed the relevant literature available on PubMed. The studied information included the formation mechanism and natural history of SA as well as its clinical manifestation, imaging characteristics, and current treatments. After reviewing the literature, we conclude that intracranial SA can be managed surgically and by endovascular embolization, but the degree of blood flow in normal brain tissue distal to the SA must be evaluated. A balloon occlusion test (BOT) or cross compression test is recommended for this evaluation. If the collateral circulation is sufficiently compensatory, direct excision or embolization can be performed. However, if the compensatory collateral circulation is poor, a bypass surgery is necessary. Satisfactory results can be achieved in the majority of SA patients after treatment. However, the size of the aneurysm may increase in some patients after endovascular treatment. Special attention should be paid to cases exhibiting a significant mass effect to avoid subsequent SA excision due to an intolerable mass effect. Satisfactory results can be achieved with careful treatment of SA.

Intracranial Serpentine Aneurysms: Spontaneous Changes of Angiographic Filling Pattern

“…The main presenting feature was symptoms related to mass effect, in which distinct symptomatology was based on the location of the aneurysm. 4,5,[8][9][10] Although it is generally accepted that serpentine aneurysms are protected against rupture by the thick fibrous wall, Suzuki et al 11 reported a 28% rate of subarachnoid hemorrhage in 39 serpentine aneurysms. Another cause of morbidity and mortality is related to ischemic stroke in the territory supplied by the serpentine aneurysm.…”

“…4,5 The pathogenesis of serpentine aneurysms is not clear, and several hypotheses have been pro-posed to explain the evolutionary features. [6][7][8] The most widely accepted mechanism is continued expansion of a saccular aneurysm into a serpentine configuration termed the "Coanda effect." 6 The common entity in the pathophysiology of serpentine aneurysms is the dynamic nature of thrombosis and aneurysm formation.…”

“…4 In the initial reports, surgical obliteration alone was the mainstay treatment; however, surgical external carotid artery (ECA)-ICA anastomosis and an endovascular approach have expanded the treatment options. 4,8 This study focused on the clinical and imaging findings of 15 patients with serpentine aneurysms treated by endovascular routes. We present cases of saccular and fusiform aneurysms evolving into serpentine aneurysms during follow-up to illustrate the possible formation mechanisms of serpentine aneurysms.…”

Aneurisma Serpentina Gigante de la Arteria Cerebral Media

“…Los AS típicos generalmente se presentan con: crisis, déficit neurológico progresivo y/o síntomas de hipertensión endocraneana subaguda o crónica que puede confundirse con un tumor como es el caso de nuestro paciente. Los AS atípicos, menos frecuentes, se presentan con sintomatología aguda: cefalea, vómitos y déficit neurológico focal brusco dado que son los que debutan con hemorragia subaracnoidea 17 .…”

“…La secuencia Eco gradiente es útil para demostrar el flujo lento en el interior del canal vascular. El canal vascular intraaneurismático puede visualizarse en la Angiografía por resonancia (AngioRM) en extrema vinculación con el PEIC y puede ayudarnos en la orientación diagnóstica, como ocurrió con nuestro paciente 1,17 .…”