Abstract
We present the case of a 17-year-old male patient with a giant middle cerebral artery (MCA) dissecting aneurysm treated with telescoping flow diverter technique with good angiographic and clinical outcome. The presence of an intracranial aneurysm in children and adolescents is rare and represents less than 1% of all intracranial aneurysms. Dissecting aneurysms have a non-saccular shape and are generally located in the MCA. Microsurgical clipping or endovascular coil occlusion is not feasible in the majority of these patients. Prior to the availability of flow diverter stents, stent-assisted coiling or telescoping stenting were the most frequently used endovascular strategies for these cases. Follow-up examinations of these patients, however, showed high recanalization rates and a substantial risk of (re-)hemorrhage. In the current era of flow diversion, the use of flow diverters to treat a dissecting aneurysm has proven to have good clinical and angiographic outcomes with a low incidence of complications. The main topic of this chapter is the management of dissecting aneurysms of the MCA.
This is a preview of subscription content, log in via an institution to check access.
References
Becske T, Kallmes DF, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Nelson PK. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology. 2013;267(3):858–68. https://doi.org/10.1148/radiol.13120099.
Burrows AM, Zipfel G, Lanzino G. Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter. J Neurointerv Surg. 2013;5(6):e47. https://doi.org/10.1136/neurintsurg-2012-010478.rep.
Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Starke RM, Hasan D, Wu C, Singhal S, Moukarzel LA, Rosenwasser R, Jabbour P. Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR Am J Neuroradiol. 2014;35(3):546–52. https://doi.org/10.3174/ajnr.A3696.
Dai D, Ding YH, Kadirvel R, Rad AE, Lewis DA, Kallmes DF. Patency of branches after coverage with multiple telescoping flow-diverter devices: an in vivo study in rabbits. AJNR Am J Neuroradiol. 2012;33(1):171–4. https://doi.org/10.3174/ajnr.A2879.
Damiano RJ, Tutino VM, Paliwal N, Ma D, Davies JM, Siddiqui AH, Meng H. Compacting a single flow diverter versus overlapping flow diverters for intracranial aneurysms: a computational study. AJNR Am J Neuroradiol. 2017;38(3):603–10. https://doi.org/10.3174/ajnr.A5062.
Drake CG, Peerless SJ. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg. 1997;87(2):141–62. https://doi.org/10.3171/jns.1997.87.2.0141.
Gawlitza M, Januel AC, Tall P, Bonneville F, Cognard C. Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: a single-center series with special emphasis on covered cortical branches and perforating arteries. J Neurointerv Surg. 2016;8(5):481–7. https://doi.org/10.1136/neurintsurg-2015-011682.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol. 2005;63(5):424–32.; discussion 432-3. https://doi.org/10.1016/j.surneu.2004.11.023.
Ikeda DS, Marlin ES, Shaw A, Powers CJ. Successful endovascular reconstruction of a recurrent giant middle cerebral artery aneurysm with multiple telescoping flow diverters in a pediatric patient. Pediatr Neurosurg. 2015;50(2):88–93. https://doi.org/10.1159/000375167.
Kabbasch C, Mpotsaris A, Behme D, Dorn F, Stavrinou P, Liebig T. Pipeline embolization device for treatment of intracranial aneurysms - the more, the better? A single-center retrospective observational study. J Vasc Interv Neurol. 2016;9(2):14–20.
Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D. Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery. 2009;64(4):632–42.; discussion 642-3; quiz N6. https://doi.org/10.1227/01.NEU.0000339109.98070.65.
Saraf R, Shrivastava M, Siddhartha W, Limaye U. Intracranial pediatric aneurysms: endovascular treatment and its outcome. J Neurosurg Pediatr. 2012;10(3):230–40. https://doi.org/10.3171/2012.5.PEDS1210.
Sorteberg A, Dahlberg D. Intracranial non-traumatic aneurysms in children and adolescents. Curr Pediatr Rev. 2013;9(4):343–52. https://doi.org/10.2174/221155281120100005.
van Rooij WJ, Sluzewski M. Perforator infarction after placement of a pipeline flow-diverting stent for an unruptured A1 aneurysm. AJNR Am J Neuroradiol. 2010;31(4):E43–4. https://doi.org/10.3174/ajnr.A2034.
Yavuz K, Geyik S, Saatci I, Cekirge HS. Endovascular treatment of middle cerebral artery aneurysms with flow modification with the use of the pipeline embolization device. AJNR Am J Neuroradiol. 2014;35(3):529–35. https://doi.org/10.3174/ajnr.A3692.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Switzerland AG
About this entry
Cite this entry
Perez, N., Viso, R., Lylyk, I., Ferrario, A., Lylyk, P. (2018). Middle Cerebral Artery Aneurysm: Dissecting Aneurysm in a Young Patient Treated with Three Flow Diverter Stents. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_65-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-70267-4_65-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-70267-4
Online ISBN: 978-3-319-70267-4
eBook Packages: Springer Reference MedicineReference Module Medicine