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Case Reports
. 2012:3:129.
doi: 10.4103/2152-7806.102944. Epub 2012 Oct 27.

Coil embolization of an intracranial aneurysm in an infant with tuberous sclerosis complex: A case report and literature review

Juneyoung L Yi  1 , Michael A Galgano, Zulma Tovar-Spinoza, Eric M Deshaies
Affiliations
Case Reports

Coil embolization of an intracranial aneurysm in an infant with tuberous sclerosis complex: A case report and literature review

Juneyoung L Yi et al. Surg Neurol Int. 2012.

Abstract

Background: Tuberous sclerosis (TS) is a multiorgan neurocutaneous syndrome. Vascular manifestations are often extracranial. There is a paucity of cases involving TS combined with intracranial aneurysms reported in the literature. As a result, treatment has not been well described.

Case description: We report the case of a 13-month-old female infant with a prior diagnosis of TS that was found to have new onset of left eye ptosis, anisocoria, and papillary mydriasis indicative of left third cranial nerve palsy. A magnetic resonance angiogram (MRA) of the brain revealed a left internal carotid artery (ICA) aneurysm. Endovascular embolization was determined to be the best option for treatment. After a successful balloon test occlusion with neuromonitoring, the left internal carotid artery was sacrificed via coil embolization.

Conclusions: This is only the third case report of endovascular coil embolization of an intracranial aneurysm in an infant with TS. We report no complications during the procedure, and the patient was discharged with resolving left third cranial nerve palsy. Neither surgical nor endovascular outcomes have been well described in the literature. Follow-up on this patient will be useful for establishing protocols of treatment.

Keywords: Hamartin; intracranial aneurysm; tuberin; tuberous sclerosis.

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Figures

Figure 1
Figure 1
MRI at initial diagnosis (a) Axial T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI showing features of tuberous sclerosis, including white matter radial migration lines and cortical tubers. MRI at presentation of cranial nerve deficits (b) Axial T2-weighted FLAIR MRI showing an 18-mm left cavernous sinus internal carotid artery aneurysm
Figure 2
Figure 2
MRA showing the same 18-mm left cavernous sinus internal carotid artery (ICA) aneurysm with extension to the petrous and distal cervical ICA
Figure 3
Figure 3
Digital subtraction angiography further characterizing the left internal carotid artery aneurysm (a) Digital subtraction angiography just prior to intervention (b)
Figure 4
Figure 4
Digital subtraction angiography following coil embolization and complete occlusion of the left cavernous, petrous, and distal cervical internal carotid artery. The contrast seen demonstrates reflux in the external carotid artery branches
See this image and copyright information in PMC

References

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