Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review
Background: Donut-shaped aneurysms are rare subtypes of partially thrombosed aneurysms that can consist of partial intraluminal thrombus induced by preferential circular laminar flow within the aneurysms. Intraluminal thrombus in a donut-shaped aneurysm might be fragile and cause thromboembolic comp...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-03-01
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| Series: | Interdisciplinary Neurosurgery |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751920304849 |
| _version_ | 1818721034527834112 |
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| author | Ryo Tamaki Ichiro Nakagawa Ryokichi Yagi Seigo Kimura Daiji Ogawa Tadashi Manno Hirokatsu Taniguchi |
| author_facet | Ryo Tamaki Ichiro Nakagawa Ryokichi Yagi Seigo Kimura Daiji Ogawa Tadashi Manno Hirokatsu Taniguchi |
| author_sort | Ryo Tamaki |
| collection | DOAJ |
| description | Background: Donut-shaped aneurysms are rare subtypes of partially thrombosed aneurysms that can consist of partial intraluminal thrombus induced by preferential circular laminar flow within the aneurysms. Intraluminal thrombus in a donut-shaped aneurysm might be fragile and cause thromboembolic complications during endovascular treatment because its pathogenesis supposedly differs from common partially thrombosed aneurysms caused by intramural hemorrhage and vasa vasorum proliferation. Here, we describe a favorable outcome of treating a symptomatic, donut-shaped, partially-thrombosed giant aneurysm by endovascular intervention under proximal flow control. Case description: A 70-year-old woman presented with a four-month history of left oculomotor nerve palsy. Cerebral angiography revealed a donut-shaped, partially-thrombosed giant aneurysm in the cavernous segment of left internal carotid artery (ICA) and slow intra-aneurysmal circular blood flow because of severe stenosis of ICA near the aneurysm. After confirming ischemic tolerance with the balloon occlusion test, the parent artery was occluded without intra-aneurysmal coil deployment under proximal flow control to prevent perioperative thromboembolic complications due to specific intraluminal thrombus migration. No new neurological deterioration was found, and the patient recovered from the oculomotor nerve palsy. Conclusion: A donut-shaped, partially-thrombosed giant aneurysm on the cavernous segment of the ICA was safely treated by endovascular trapping under proximal flow control. Careful preoperative assessment and an optimal treatment strategy is required to prevent thromboembolism caused by the migration of intraluminal fragile thrombus. |
| first_indexed | 2024-12-17T20:32:19Z |
| format | Article |
| id | doaj.art-b3b45f99732e4f929d7cba76157bfa20 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-17T20:32:19Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-b3b45f99732e4f929d7cba76157bfa202022-12-21T21:33:32ZengElsevierInterdisciplinary Neurosurgery2214-75192021-03-0123100923Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature reviewRyo Tamaki0Ichiro Nakagawa1Ryokichi Yagi2Seigo Kimura3Daiji Ogawa4Tadashi Manno5Hirokatsu Taniguchi6Department of Neurosurgery, Osaka General Medical Center, Osaka, Japan; Kouzenkai Yagi Neurosurgical Hospital, Osaka, JapanDepartment of Neurosurgery, Nara Medical University, Nara, Japan; Corresponding author at: Departments of Neurosurgery, Nara Medical University, Shijo-cho 840, Kashihara-city, Nara 634-8521, Japan.Kouzenkai Yagi Neurosurgical Hospital, Osaka, Japan; Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Osaka, JapanKouzenkai Yagi Neurosurgical Hospital, Osaka, JapanKouzenkai Yagi Neurosurgical Hospital, Osaka, JapanKouzenkai Yagi Neurosurgical Hospital, Osaka, JapanKouzenkai Yagi Neurosurgical Hospital, Osaka, JapanBackground: Donut-shaped aneurysms are rare subtypes of partially thrombosed aneurysms that can consist of partial intraluminal thrombus induced by preferential circular laminar flow within the aneurysms. Intraluminal thrombus in a donut-shaped aneurysm might be fragile and cause thromboembolic complications during endovascular treatment because its pathogenesis supposedly differs from common partially thrombosed aneurysms caused by intramural hemorrhage and vasa vasorum proliferation. Here, we describe a favorable outcome of treating a symptomatic, donut-shaped, partially-thrombosed giant aneurysm by endovascular intervention under proximal flow control. Case description: A 70-year-old woman presented with a four-month history of left oculomotor nerve palsy. Cerebral angiography revealed a donut-shaped, partially-thrombosed giant aneurysm in the cavernous segment of left internal carotid artery (ICA) and slow intra-aneurysmal circular blood flow because of severe stenosis of ICA near the aneurysm. After confirming ischemic tolerance with the balloon occlusion test, the parent artery was occluded without intra-aneurysmal coil deployment under proximal flow control to prevent perioperative thromboembolic complications due to specific intraluminal thrombus migration. No new neurological deterioration was found, and the patient recovered from the oculomotor nerve palsy. Conclusion: A donut-shaped, partially-thrombosed giant aneurysm on the cavernous segment of the ICA was safely treated by endovascular trapping under proximal flow control. Careful preoperative assessment and an optimal treatment strategy is required to prevent thromboembolism caused by the migration of intraluminal fragile thrombus.http://www.sciencedirect.com/science/article/pii/S2214751920304849AneurysmDonut signParent artery occlusionProximal flow control |
| spellingShingle | Ryo Tamaki Ichiro Nakagawa Ryokichi Yagi Seigo Kimura Daiji Ogawa Tadashi Manno Hirokatsu Taniguchi Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review Interdisciplinary Neurosurgery Aneurysm Donut sign Parent artery occlusion Proximal flow control |
| title | Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review |
| title_full | Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review |
| title_fullStr | Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review |
| title_full_unstemmed | Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review |
| title_short | Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review |
| title_sort | donut shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control technical case report and literature review |
| topic | Aneurysm Donut sign Parent artery occlusion Proximal flow control |
| url | http://www.sciencedirect.com/science/article/pii/S2214751920304849 |
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