[Embolitic material (coils) dislocation inside a giant and cerebral aneurysm and morphological aneurysm changes after...

The placement of tungsten coils into aneurysm sack in patient after SAH is a method of treatment used in many neurosurgical departments. The main indications for coiling procedures are severe neurological status (IV i V according to WFNS) and posterior circulation aneurysms. Coiling can be offered to a patient who does not agree to clipping procedure. The presented case is a patient with a giant MCA aneurysm who did not agree to clipping procedure and, therefore, was subjected to coiling. During the follow-up of 2 months; control skull X-rays and after them control angiography were performed to monitor coils arrangement in the aneurysm sack and their possible dislocation. The control angiography after 6 months showed significant enlargement of the aneurysm. The aneurysm was clipped, totally excised and subjected to histopathological examination. It was found that the material inside the aneurysm sack can change its shape due to the impact of the flowing blood (change in the coil shape, resorption and the recanalization of the clot) similarly to the natural process of aneurysm development. Morphological changes of the aneurysm appear to be also possible in spite of the thrombus formation in the aneurysm sack.