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Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report.
Metadata
Journalbmc neurology2.356Date
2020 Jun 06
5 months ago
Type
Journal Article
Volume
2020-Jun-06 / 20 : 232
Author
García-Pérez D 1, Panero I 2, Eiriz C 2, Moreno LM 2, Munarriz PM 2, Paredes I 2, Lagares A 2, Alén JF 2
Affiliation
  • 2. Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain.
Doi
PMIDMESH
Basilar Artery
Brain Edema
Female
Humans
Intracranial Aneurysm
Magnetic Resonance Imaging
Middle Aged
Thrombosis
Ventriculoperitoneal Shunt
Abstract
BACKGROUND: Partially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm.
CASE PRESENTATION: We performed a proximal surgical basilar artery occlusion on a 64-year-old female with a partially thrombosed giant BA aneurysm. MRI showed no ischemic lesions but showed marked edema adjacent to the aneurysm. She had a good recovery, but 3 months after surgical occlusion, her gait deteriorated together with urinary incontinence and worsening right hemiparesis. MRI showed that the aneurysm had grown and developed intramural hemorrhage, which caused extensive brain edema and obstructive hydrocephalus. She was treated by a ventriculoperitoneal shunt placement. Follow-up MRI showed progressive brain edema resolution, complete thrombosis of the lumen and shrinkage of the aneurysm. At 5 years follow-up the patient had an excellent functional outcome.
CONCLUSIONS: Delayed growth of a surgically treated and thrombosed giant aneurysm from wall dissection demonstrates that discontinuity with the initial parent artery does not always prevent progressive enlargement. The development of transmural vascular connections between the intraluminal thrombus and adventitial neovascularization by the vasa vasorum on the apex of the BA seems to be a key event in delayed aneurysm growth. Extensive brain edema might translate an inflammatory edematous reaction to an abrupt enlargement of the aneurysm.
Keywords: Basilar apex aneurysm Brain edema Hunterian occlusion
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BMC Neurolbmc neurology
Metadata
LocationEngland
FromBMC

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