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Case Reports
. 2015 Oct-Dec;10(4):327-30.
doi: 10.4103/1793-5482.162721.

The unusual angiographic course of intracranial pseudoaneurysms

Mario Zanaty  1 , Nohra Chalouhi  1 , Pascal Jabbour  1 , Robert M Starke  2 , David Hasan  3
Affiliations
Case Reports

The unusual angiographic course of intracranial pseudoaneurysms

Mario Zanaty et al. Asian J Neurosurg. 2015 Oct-Dec.

Abstract

Although rare, traumatic intracranial pseudoaneurysms remain one of the most difficult vascular lesions to diagnose and treat. A 55-year-old male patient underwent endoscopic endonasal transphenoidal resection for a pituitary macroadenoma. The operation was complicated by an arterial bleed. The initial angiogram revealed pseudoaneurysm of the anterior choroidal artery. Although the pseudoaneurysm completely disappeared on the second angiogram, it was surprisingly found to have enlarged on the third angiogram. The lesion was successfully treated with flow-diversion using a pipeline embolization device. The present case demonstrates that the natural history of iatrogenic pseudoaneurysms may be unpredictable and misleading. Traumatic pseudoaneurysms should, therefore, be carefully followed when conservative treatment is elected or when the lesion seems to have spontaneously regressed. Flow-diversion seems to be a reasonable treatment option.

Keywords: Flow-diversion; intracranial aneurysms; pipeline; traumatic pseudoaneurysms.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Preoperative magnetic resonance imaging showing a pituitary macroadenoma
Figure 2
Figure 2
Perioperative angiogram showing a small pouch suggestive of pseudoaneurysm, just below the level of the takeoff of the left anterior choroidal artery
Figure 3
Figure 3
Second postoperative day angiogram showing a complete resolution of the pouch and disappearance of the pseudoaneurysm
Figure 4
Figure 4
Angiogram, 1-week after the surgery before pipeline embolization device placement, shows a 1.5 mm × 1.3 mm left internal carotid artery pseudoaneurysm
Figure 5
Figure 5
Angiogram after pipeline embolization device placement shows no evidence of stenosis, proximal, distal, or within the device, and there is no evidence of embolus or occlusion at any of the intracranial vessels
See this image and copyright information in PMC

References

    1. Shigeta H, Kyoshima K, Nakagawa F, Kobayashi S. Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta Neurochir (Wien) 1992;119:42–8. - PubMed
    1. Abe M, Tabuchi K, Yokoyama H, Uchino A. Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg. 1998;89:419–24. - PubMed
    1. Kim BM, Kim DI, Chung EC, Kim SY, Shin YS, Park SI, et al. Endovascular coil embolization for anterior choroidal artery aneurysms. Neuroradiology. 2008;50:251–7. - PubMed
    1. Lee BH, Kim BM, Park MS, Park SI, Chung EC, Suh SH, et al. Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery. J Neurosurg. 2009;110:431–6. - PubMed
    1. Lee JW, Choi HG, Jung JY, Huh SK, Lee KC. Surgical strategies for ruptured blister-like aneurysms arising from the internal carotid artery: A clinical analysis of 18 consecutive patients. Acta Neurochir (Wien) 2009;151:125–30. - PubMed

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