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Endovascular internal trapping of traumatic pericallosal pseudoaneurysm with hydrogel-coated self-expandable coil in
Sook Young Sim1, Yong Sam Shin, Soo Han Yoon
1Department of Neurosurgery, Ajou University School of Medicine, Suwon, South Korea 443-721.
Insights
A novel technique using hydrogel-coated coils successfully treated a traumatic pericallosal pseudoaneurysm in a child. This short-segment trapping preserves blood flow, offering a promising alternative for pediatric intracranial aneurysms.
Area of Science:
- Pediatric neurosurgery
- Endovascular neurosurgery
- Cerebrovascular disease
Background:
- Traumatic intracranial pseudoaneurysms in children carry a high rebleeding risk, necessitating secure treatment.
- Parent artery trapping can lead to distal ischemia and perforator injury.
- Existing treatments pose risks, highlighting the need for safer alternatives.
Observation:
- A 5-year-old boy presented with altered mental status and lower extremity weakness after blunt trauma.
- Neuroimaging revealed a traumatic pericallosal artery pseudoaneurysm.
- Endovascular short segmental internal trapping was performed using hydrogel-coated self-expandable coils.
Findings:
- The procedure successfully obliterated the pseudoaneurysm.
- Distal collateral blood flow was maintained.
- The patient experienced a good clinical recovery with no rebleeding at 3-month follow-up.
Implications:
- Short-segment occlusion with hydrogel-coated coils is a potential alternative for distal anterior cerebral artery traumatic pseudoaneurysms in children.
- This technique may mitigate risks associated with traditional parent artery trapping.
- Further research is needed to establish the definitive safety and reliability of this approach.
Background:
Traumatic intracranial pseudoaneurysms in children must be completely secured from the parent artery because of significant morbidity and mortality from the high risk of rebleeding. However, the trapping of the parent artery involves the risk of ischemia changes distal to the trapped artery and the perforator injury. We describe a first case in the literature of successful trapping in the short segment with hydrogel-coated self-expandable coil in a child with a traumatic pericallosal pseudoaneurysm.
Case Description:
A 5-year-old boy was admitted to our institution after enduring a blunt trauma with a stuporous mentality. Initial neuroimaging revealed a small hemorrhage in the corpus callosum with subarachnoid hemorrhage. Two weeks later, computed tomogram showed new callosal hemorrhage and a 4.7 x 5-mm pseudoaneurysm of the right pericallosal artery with mental deterioration and weakness of lower extremity. An endovascular short segmental internal trapping (5 mm) of the right pericallosal artery was conducted to save collateral blood flow, using 2 hydrogel-coated self-expandable coils. The cerebral angiogram of immediately after the trapping and at 3 months' follow-up revealed that the aneurysm had been completely obliterated, with successful maintenance of the distal collateral flow from the contralateral pericallosal artery. The patient recovered with good clinical outcome.
Conclusion:
We suggest that short-segment occlusion by a hydrogel-coated self-expandable coil has become a good alternative for the treatment of traumatic pseudoaneurysms in the distal anterior cerebral artery, although the safety and reliability of this procedure is as yet not definitely proven.
