We present a case of a partially thrombosed giant aneurysm of the pericallosal artery
that experienced a temporary worsening of perianeurysmal edema after clipping. A 66-year-old
man presented with progressive weakness of the right leg. Imaging studies revealed
a partially thrombosed giant aneurysm at the bifurcation of the left pericallosal
artery with concomitant perianeurysmal edema. The aneurysm was thought responsible
for the symptoms of the patient, and he agreed to undergo clipping surgery. The aneurysmal
neck was clipped using two long aneurysm clips without dissecting the aneurysmal dome.
The patient woke up from anesthesia with the right-sided hemiparesis, which progressed
to hemiplegia by 12 h after surgery. Brain computed tomography revealed worsening
of the perianeurysmal edema. Fortunately, his symptoms resolved completely by 2 weeks
after surgery with conservative management. Perianeurysmal edema is frequently observed
in patients with partially thrombosed giant aneurysms. Although worsening of perianeurysmal
edema is a relatively common complication of endovascular procedures, its occurrence
after clipping has rarely been reported. The worsening may have been induced by release
of inflammatory cytokines from aneurysm wall, which was rendered ischemic due to obliteration
of the vasa vasorum by the clips. Perianeurysmal edema may develop or worsen after
clipping of a partially thrombosed giant aneurysm if the interface between the aneurysm
and surrounding brain is not fully dissected.
Key-words:
Clipping - giant aneurysm - perianeurysmal edema - vasa vasorum
