Abstract
Proximal occlusion or trapping combined with EC-IC bypass is usually employed as a
definite treatment for a giant fusiform aneurysm in cases where it is impossible to
apply clips and do vascular reconstruction. Endovascular treatment is very important
as an alternative or combined technique if direct surgery is impossible. The authors
report a young male who presented with a 2nd episode of intracranial bleeding in basal ganglion and subarachnoid hemorrhage with
mild right hemiparesis. His 3D-CT scan revealed left ruptured partially thrombosed
giant M1 fusiform aneurysm and left unruptured C3 saccular aneurysm. He underwent
STA-MCA bypass with attempted M1 reconstruction and a week later attempted total occlusion
of the M1 aneurysm with coils. But only a ruptured point at the distal M1 was occluded
which, however, resulted in temporary mild right hemiparesis and aphasia. A month
later when he was supposed to have his 2nd coiling procedure his angiogram demonstrated spontaneous and complete obliteration
of both the M1 and C3 aneurysms without any new neurological deficit, so no further
endovascular procedure was attempted. The discussion is based on this case and previous
reports regarding difficult giant M1 fusiform aneurysms, its treatment and spontaneous
thrombosis of aneurysmal sac after bypass and distal occlusion. Conclusions are drawn
that 1) spontaneous thrombosis of M1 and C3 aneurysms should be the result of hemodynamic
alteration in both aneurysms due to a lower flow velocity induced by distal bypass
and distal occlusion of M1, 2) combined distal bypass and endovascular obliteration
of the aneurysmal sac with coils is a good alternative if vascular reconstruction
is difficult or impossible.
Key words
Giant Fusiform Aneurysm - Spontaneous and Complete Thrombosis - Flow Alteration -
Coil Embolization
References
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