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Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum

Authors :
Akio Soeda
Nobuyuki Sakai
Chikao Yutani
Naoaki Yamada
Izumi Nagata
Hatsue Ishibashi-Ueda
Kenichi Murao
Koji Iihara
Source :
Journal of Neurosurgery. 98:407-413
Publication Year :
2003
Publisher :
Journal of Neurosurgery Publishing Group (JNSPG), 2003.

Abstract

✓ A 58-year-old woman harboring a partially thrombosed giant aneurysm of the vertebral artery (VA) presented with lower cranial nerve palsies and cerebellar ataxia. The authors initially attempted to reduce the mass effect by obliterating the lumen of the aneurysm as well as by trapping of the parent artery with coils. Although there was no angiographically demonstrated evidence of filling, the aneurysm continued to enlarge. Magnetic resonance imaging revealed a marked enhancement around the packed coils close to the neck of the aneurysm. Aneurysmectomy and removal of the coils were performed and resulted in an almost complete cure of the patient's symptoms. Interestingly, at the time of resection, a marked development of vasa vasorum on the occluded VA and the neck of the aneurysm was noted. When the occluded VA was cut, there was blood oozing through the coils packed within its lumen on the side where the aneurysm lay. Histological examination showed the presence of inflammatory cells and neovascularization of a partially organized thrombus around the packed coils in both the aneurysm and occluded VA. The proliferation of vasa vasorum was also recognized histologically. This unique case provides insight into the growth mechanisms of a partially thrombosed giant aneurysm after an apparently complete occlusion by endovascular treatment, especially the role of vaso vasorum on the occluded parent artery in the dynamic process of neovascularization in the incomplete organization of thrombus around the packed coils.

Details

ISSN :
00223085
Volume :
98
Database :
OpenAIRE
Journal :
Journal of Neurosurgery
Accession number :
edsair.doi.dedup.....143a93977e86a3a687651879496548bc
Full Text :
https://doi.org/10.3171/jns.2003.98.2.0407