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Takeda K, Oda K, Fukumoto H, Kobayashi H, Morishita T, Takemoto K, Iwaasa M, Abe H. Repeated coil embolization of traumatic basilar artery pseudoaneurysm accompanied by bilateral traumatic internal carotid artery stenosis following severe head injury in a pediatric patient: A case report and literature review. Surg Neurol Int 2023; 14:199. [PMID: 37404524 PMCID: PMC10316180 DOI: 10.25259/sni_267_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Background Few cases of pediatric traumatic intracranial aneurysms (pTICAs) in the posterior circulation involving the basilar artery (BA) following severe head trauma have been reported. Here, we describe a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic internal carotid artery (ICA) stenosis following blunt head trauma. Case Description A 16-year-old boy presented to our emergency department after being hit by a car. The patient was initially diagnosed with multiple skull base fractures underlying traumatic subarachnoid hemorrhage and left acute epidural hematoma. Seven days following emergency craniectomy, magnetic resonance imaging revealed bilateral ICA stenosis, BA stenosis, and BA pseudoaneurysm. We decided to perform coil embolization, resulting in body filling and a volume embolization ratio of 15.7%. Twenty-eight days after coil embolization, digital subtraction angiography revealed aneurysmal rupture. We performed repeated coil embolization, resulting in body filling and a volume embolization ratio of 20.9%. Conclusion We reported a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic ICA stenosis following a severe head injury treated with repeated coil embolization. Considering the risk of further brain injury due to high incidence of rupture, early vascular survey and appropriate treatment may be the most important prognostic factors in pTICAs.
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Affiliation(s)
| | - Kazunori Oda
- Corresponding author: Kazunori Oda, Department of Neurosurgery, Fukuoka University, Fukuoka, Japan.
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Grover PJ, Harris L, Qureshi AM, Rennie A, Robertson F, James G. Occult posterior inferior cerebellar artery dissection requiring endovascular treatment following pediatric head trauma: case report. J Neurosurg Pediatr 2021; 27:643-648. [PMID: 33836497 DOI: 10.3171/2020.11.peds18324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
This is the eighth case report of a pediatric dissecting posterior inferior cerebellar artery aneurysm. The authors present the case of a 13-year-old boy who presented with posttraumatic posterior fossa subdural, subarachnoid, and intraventricular hemorrhage with hydrocephalus. Initial vascular imaging findings were negative; however, a high level of suspicion is necessary. The aneurysm was identified on day 20, after recurrence of hydrocephalus, and was treated with endovascular vessel sacrifice. The patient made a good recovery. It is important to consider arterial dissection in pediatric traumatic brain injury, especially with suspicious findings on initial CT scan and clinical presentation out of proportion to the mechanism of injury. Delayed vascular imaging is imperative for appropriate management.
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Affiliation(s)
- Patrick J Grover
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Lauren Harris
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Ayman M Qureshi
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Adam Rennie
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Fergus Robertson
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Greg James
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
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Sujijantarat N, Pierson MJ, Kemp J, Coppens JR. Staged Trapping of Traumatic Basilar Trunk Pseudoaneurysm: Case Report and Review of Literature. World Neurosurg 2017; 108:991.e7-991.e12. [PMID: 28866061 DOI: 10.1016/j.wneu.2017.08.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) of the posterior circulation in the pediatric populations are rare. Only a few reports in the literature document basilar artery TICA in the pediatric population. These cases were typically associated with a clival fracture and commonly diagnosed weeks to months after trauma. We present a case of a patient with a basilar TICA diagnosed after a motor vehicle collision treated with staged trapping and review of the literature. CASE DESCRIPTION We present a case of a 14-year-old boy who sustained a high-speed motor vehicle collision and developed a basilar trunk TICA identified on admission. Initially, the patient underwent craniotomy for proximal sacrifice of the basilar artery in hope for spontaneous thrombosis of the aneurysm through flow reversal. Endovascular options were reviewed and felt to be less feasible than surgical trapping. Due to continued filling through the right posterior communicating artery, the second surgery was performed to distally trap the aneurysm. The aneurysm was opened, showing some thrombosis and the absence of flow. Repeat magnetic resonance imaging did not reveal any new infarction, and the patient was discharged with neurologic improvement over time. At 1 year, he was able to ambulate unassisted and had a modified Rankin Scale score of 3. CONCLUSION Development of a TICA may be more acute than literature previously suggested. Treatment consists of a wide range of options and should be considered, especially in the pediatric population, to prevent rupture. Trapping can be performed safely if adequate collateral flow is present in the setting of a large basilar artery aneurysm.
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Affiliation(s)
| | - Matthew J Pierson
- Department of Neurosurgery, Saint Louis University, Saint Louis, Missouri, USA
| | - Joanna Kemp
- Department of Neurosurgery, Saint Louis University, Saint Louis, Missouri, USA
| | - Jeroen R Coppens
- Department of Neurosurgery, Saint Louis University, Saint Louis, Missouri, USA.
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Subarachnoid haemorrhage secondary to traumatic intracranial aneurysm of the posterior cerebral circulation: case series and literature review. Acta Neurochir (Wien) 2016; 158:1731-40. [PMID: 27364895 PMCID: PMC4980416 DOI: 10.1007/s00701-016-2865-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/02/2016] [Indexed: 12/03/2022]
Abstract
Background To identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Subjects included 26 patients aged 3–54 (mean 24.8). Methods Case series and literature search to identify all reported cases. Results In our series, two of three cases were fatal as a result of rebleed, and one case had a good outcome with no deficit, following prompt diagnosis and embolisation. Our key findings from the literature review were: 30.7 % of patients were age 16 and under; 88 % had an acute drop in consciousness, 46 % in a delayed manner; the mean time to diagnosis was 7.5 days; initial cerebrovascular imaging was normal in 23 %; the rebleed rate was 23 %; 61 % required emergency diversion of cerebrospinal fluid; 11 % developed vasospasm requiring treatment; 19.2 % had deficits that rendered them unable to live independently. The mortality rate was 27 %. Conclusions SAH from ruptured posterior circulation TICA is associated with significant morbidity and mortality. A high index of suspicion as well as prompt diagnosis, repeat imaging in selected cases, and treatment of any associated TICA can be crucial to a favourable outcome.
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Han JH, Koh EJ, Choi HY, Park JS, Lee JM. Visualization of a Traumatic Pseudoaneurysm at Internal Carotid Artery Bifurcation due to Blunt Head Injury: A Case Report. Korean J Neurotrauma 2014; 10:126-9. [PMID: 27169047 PMCID: PMC4852601 DOI: 10.13004/kjnt.2014.10.2.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 12/02/2022] Open
Abstract
Traumatic intracranial pseudoaneurysms occurring after blunt head injuries are rare. We report an unusual case of subarachnoid hemorrhage (SAH) caused by rupturing of the traumatic pseudoaneurysm of the internal carotid artery (ICA) bifurcation that resulted from a non-penetrating injury. In a patient with severe headache and SAH in the right sylvian cistern, which developed within 7 days after a blunt-force head injury, a trans-femoral cerebral angiogram (TFCA) showed aneurysmal sac which was insufficient to confirm the pseudoaneurysm. We obtained a multi-slab image of three dimensional time of flight (TOF) of magnetic resonance angiography (MRA). The source image of the gadolinium-enhanced MRA revealed an intimal flap within the intracranial ICA bifurcation, providing a clue for the diagnosis of a dissecting pseudoaneurysm at the ICA bifurcation due to blunt head trauma. We performed direct aneurysmal neck clipping, without neurological deficit. A follow-up TFCA did not show either aneurysm sac or luminal narrowing. We suggest that in the patient with a history of blunt head injury with SAH following shortly, multi-slab image of 3D TOF MRA can give visualization of the presence of a pseudoaneurysm.
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Affiliation(s)
- Ju-Hee Han
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Eun-Jeong Koh
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Ha-Young Choi
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Jung-Soo Park
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Jong-Myong Lee
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
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Gemmete JJ, Toma AK, Davagnanam I, Robertson F, Brew S. Pediatric Cerebral Aneurysms. Neuroimaging Clin N Am 2013; 23:771-9. [DOI: 10.1016/j.nic.2013.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kristoffersen S, Vetti N, Morild I. Traumatic dissection of the vertebral artery in a toddler following a short fall. Forensic Sci Int 2012; 221:e34-8. [PMID: 22633312 DOI: 10.1016/j.forsciint.2012.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/04/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
Spontaneous subarachnoid haemorrhage (SAH) in children is uncommon, but is sometimes seen after rupture of aneurysms, and in different disorders. Traumatic SAH is common after serious accidental head injury, but is also reported after child abuse with vigorous shaking. To avoid unnecessary accusations of innocent care givers, it is important not to misinterpret the findings as abusive head trauma in small children with SAH. In the presented case, a nearly two-year-old girl was brought to the hospital after a fall witnessed by her father. The girl was unconscious, with elevated intracranial pressure, SAH and bilateral retinal haemorrhage (RH). She was pronounced dead after 9h. Premortem angiography revealed a dissection of the right vertebral artery, and postmortem examination revealed a traumatic lesion deep in the neck, at the base of the skull. Cerebral edema, in combination with SAH and RH, is highly suggestive of abusive head trauma. However, no external lesions, no skeletal lesions, especially no long bone metaphyseal lesions, or subdural haematomas occurring at the same time as SAH, were found. There was no report of previous child abuse in the family. Based on the radiological and postmortem findings, we believe that an accidental fall caused a blunt force trauma with a subsequent dissection of the right vertebral artery. To our knowledge, accidental tear of one of the vertebral arteries, leading to SAH in a toddler, has previously not been described. Child abuse is an important exclusion diagnosis with serious legal implications.
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Fulkerson DH, Voorhies JM, McCanna SP, Payner TD, Leipzig TJ, Scott JA, DeNardo AJ, Redelman K, Horner TG. Endovascular treatment and radiographic follow-up of proximal traumatic intracranial aneurysms in adolescents: case series and review of the literature. Childs Nerv Syst 2010; 26:613-20. [PMID: 20177686 DOI: 10.1007/s00381-010-1104-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 01/29/2010] [Indexed: 12/16/2022]
Abstract
PURPOSE Traumatic intracranial aneurysms are rare lesions that are relatively more common in the pediatric population. Proximal traumatic aneurysms occur near the skull base. Direct surgical repair of these lesions is difficult due to the anatomically confined area, clinical status of a head injury patient, and the transmural nature of the injury. These lesions often lack a definable neck or wall suitable for clipping. While the indications and capabilities of endovascular treatment continue to expand, there are unanswered questions about the durability of treatment, especially in young patients. There are few reports examining the radiographic outcomes of endovascular treatment specifically for traumatic intracranial aneurysms. Therefore, we examined our experience treating these rare proximal lesions in an adolescent population. METHODS A retrospective review of prospectively collected data from 2000-2008 in a large, multidisciplinary neurovascular and trauma center was performed. RESULTS Three pediatric patients received endovascular treatment for traumatic intracranial aneurysms near the skull base. All patients had successful obliteration of their lesion without vessel sacrifice; however, two patients required multiple procedures for coil compaction or refilling of the aneurysm. There were no complications or ischemic events related to treatment. Follow-up imaging ranged from 6 months to 3.5 years. CONCLUSIONS Traumatic intracranial aneurysms at the skull base can be successfully treated with endovascular methods; however, close follow-up is necessary.
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Affiliation(s)
- Daniel H Fulkerson
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Ong CK, Ong MT, Lam DV, Wenderoth JD. Catastrophic delayed rupture of a traumatic aneurysm of the distal superior cerebellar artery in a child. J Clin Neurosci 2010; 17:515-7. [DOI: 10.1016/j.jocn.2009.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 06/18/2009] [Accepted: 06/21/2009] [Indexed: 10/19/2022]
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Agid R, Jonas Kimchi T, Lee SK, Ter Brugge KG. Diagnostic characteristics and management of intracranial aneurysms in children. Neuroimaging Clin N Am 2007; 17:153-63. [PMID: 17645967 DOI: 10.1016/j.nic.2007.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Childhood aneurysms have special characteristics different from adults' aneurysms. Their features were found to significantly differ from aneurysms in adults especially in their gender prevalence, location, morphology and underlying etiology. Treatment options include both surgical and endovascular methods. Whenever possible, endovascular treatment for pediatric aneurysms is the recommended approach, since it offers both reconstructive and deconstructive techniques, durable results and better clinical outcome.
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Affiliation(s)
- Ronit Agid
- Division of Neuroradiology, Toronto Western Hospital, Department of Medical Imaging, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada.
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