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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
18:50

Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment

Published on: September 25, 2009

Post-embolisation flow disturbances at the basilar tip triggering the development of an arterial aneurysm. A case

G Rodesch1, P Van Bogaert, H Szliwowski

  • 1Clinique de Neuroradiologie, Hôpital Erasme; Bruxelles, Belgium.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|August 3, 2010
PubMed

Insights

This case study details a child

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Intracerebral and intraventricular hemorrhage in children can result from arteriovenous malformations (AVMs).
  • Ruptured AVMs present with severe neurological deficits, including headaches, cranial nerve palsies, visual field defects, and aphasia.

Purpose of the Study:

  • To describe the endovascular management of a pediatric patient with a large temporal lobe AVM.
  • To highlight potential complications of AVM embolization and long-term sequelae, such as aneurysm formation.

Main Methods:

  • Endovascular embolization using acrylic glue (Histoacryl) in two sessions to obliterate the AVM nidus.
  • Management of an intra-procedural complication involving glue embolus in the basilar artery with anticoagulation.
  • Long-term clinical and angiographic follow-up to monitor AVM treatment and detect delayed complications.

Main Results:

  • Successful obliteration of approximately 90% of the AVM nidus.
  • Temporary basilar artery complication managed successfully with anticoagulation, with no permanent neurological deficit.
  • Development of a basilar tip aneurysm three years post-embolization, attributed to flow dynamics and vascular wall changes.

Conclusions:

  • Endovascular embolization is an effective treatment for pediatric intracranial AVMs, though complications can occur.
  • Long-term surveillance is crucial to identify delayed vascular changes, including aneurysm formation, secondary to altered hemodynamics.
  • Management of basilar artery complications requires careful consideration of anticoagulation and potential thrombotic risk.
Abstract

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