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CC BY-NC-ND 4.0 · Asian J Neurosurg 2018; 13(03): 779-781
DOI: 10.4103/ajns.AJNS_213_16
Case Report

Temporary worsening of perianeurysmal edema following clipping of a partially thrombosed giant pericallosal artery aneurysm

Joji Inamasu
Department of Neurosurgery, Fujita Health University Hospital, Toyoake
,
Shunsuke Nakae
Department of Neurosurgery, Fujita Health University Hospital, Toyoake
,
Yoko Kato
Department of Neurosurgery, Fujita Health University Hospital, Toyoake
,
Yuichi Hirose
Department of Neurosurgery, Fujita Health University Hospital, Toyoake
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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


Publication History

Article published online:
14 September 2022

© 2018. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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