CURATIVE RECONSTRUCTION OF A GIANT MIDBASILAR TRUNK ANEURYSM WITH THE PIPELINE EMBOLIZATION DEVICE

被引:153
作者
Fiorella, David [1 ]
Kelly, Michael E. [2 ]
Albuquerque, Felipe C.
Nelson, Peter K. [3 ,4 ]
机构
[1] Barrow Neurosurg Associates, Sect Endovasc Neurosurg, Dept Neurosurg, Barrow Neurol Inst, Phoenix, AZ 85013 USA
[2] Univ Saskatchewan, Royal Univ Hosp, Div Neurosurg, Saskatoon, SK, Canada
[3] NYU, Dept Neurosurg, New York, NY 10016 USA
[4] NYU, Dept Neuroradiol, New York, NY 10016 USA
关键词
Basilar artery; Giant aneurysm; Pipeline embolization device; INTRACRANIAL ANEURYSMS; ENDOVASCULAR TREATMENT; CEREBRAL ANEURYSMS; COILS;
D O I
10.1227/01.NEU.0000337576.98984.E4
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: To demonstrate the curative reconstruction of a giant circumferential basilar trunk aneurysm using the Pipeline embolization device (PED) (Chestnut Medical Technologies, Inc., Menlo Park, CA) alone, without embolization coils. METHODS: A 13-year-old female patient was referred for the treatment of a 4-cm, partially thrombosed, circumferential midbasilar trunk aneurysm. Her presenting symptoms included headache, nystagmus, and left upper-extremity ataxia. Open surgical and conventional endovascular treatment options were thought to be of unacceptably high risk and unlikely to achieve a definitive treatment. The patient underwent PED treatment under a Food and Drug Administration compassionate use exemption. RESULTS: An endovascular construct was built across the affected segment of the basilar trunk with 7 serially placed, telescoping PEDs, which bridged the 29-mm aneurysm neck. Completion angiography demonstrated considerably decreased flow into the aneurysm, with stasis persisting into the venous phase of angiography. No technical complications were encountered. No new neurological symptoms were evident, and the patient's original presenting symptoms resolved completely within 24 hours after the procedure. She was discharged on postoperative Day 3. Computed tomography performed on postoperative Day 5 demonstrated no change in the size of the collective aneurysm-thrombus mass. Conventional angiography performed on postoperative Day 7 showed anatomic reconstruction of the basilar artery and complete occlusion of the circumferential aneurysm. The patient remains neurologically normal. CONCLUSION: The PED provides a safe and definitive constructive treatment option for large, giant, and fusiform/circumferential aneurysms. The PED can achieve complete aneurysm Occlusion without embolization coils. When applied judiciously, the PED may be used safely in vascular segments that give rise to eloquent perforators.
引用
收藏
页码:212 / 217
页数:6
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