Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report
Abstract Background Partially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm. Case presen...
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doaj-2129ba4e72014a98acb4e72da39b71602020-11-25T03:34:40ZengBMCBMC Neurology1471-23772020-06-012011910.1186/s12883-020-01819-9Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case reportDaniel García-Pérez0Irene Panero1Carla Eiriz2Luis Miguel Moreno3Pablo M. Munarriz4Igor Paredes5Alfonso Lagares6José F. Alén7Department of Neurosurgery, University Hospital 12 de OctubreDepartment of Neurosurgery, University Hospital 12 de OctubreDepartment of Neurosurgery, University Hospital 12 de OctubreDepartment of Neurosurgery, University Hospital 12 de OctubreDepartment of Neurosurgery, University Hospital 12 de OctubreDepartment of Neurosurgery, University Hospital 12 de OctubreDepartment of Neurosurgery, University Hospital 12 de OctubreDepartment of Neurosurgery, University Hospital 12 de OctubreAbstract Background Partially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm. Case presentation We performed a proximal surgical basilar artery occlusion on a 64-year-old female with a partially thrombosed giant BA aneurysm. MRI showed no ischemic lesions but showed marked edema adjacent to the aneurysm. She had a good recovery, but 3 months after surgical occlusion, her gait deteriorated together with urinary incontinence and worsening right hemiparesis. MRI showed that the aneurysm had grown and developed intramural hemorrhage, which caused extensive brain edema and obstructive hydrocephalus. She was treated by a ventriculoperitoneal shunt placement. Follow-up MRI showed progressive brain edema resolution, complete thrombosis of the lumen and shrinkage of the aneurysm. At 5 years follow-up the patient had an excellent functional outcome. Conclusions Delayed growth of a surgically treated and thrombosed giant aneurysm from wall dissection demonstrates that discontinuity with the initial parent artery does not always prevent progressive enlargement. The development of transmural vascular connections between the intraluminal thrombus and adventitial neovascularization by the vasa vasorum on the apex of the BA seems to be a key event in delayed aneurysm growth. Extensive brain edema might translate an inflammatory edematous reaction to an abrupt enlargement of the aneurysm.http://link.springer.com/article/10.1186/s12883-020-01819-9Basilar apex aneurysmHunterian occlusionBrain edema |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Daniel García-Pérez Irene Panero Carla Eiriz Luis Miguel Moreno Pablo M. Munarriz Igor Paredes Alfonso Lagares José F. Alén |
spellingShingle |
Daniel García-Pérez Irene Panero Carla Eiriz Luis Miguel Moreno Pablo M. Munarriz Igor Paredes Alfonso Lagares José F. Alén Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report BMC Neurology Basilar apex aneurysm Hunterian occlusion Brain edema |
author_facet |
Daniel García-Pérez Irene Panero Carla Eiriz Luis Miguel Moreno Pablo M. Munarriz Igor Paredes Alfonso Lagares José F. Alén |
author_sort |
Daniel García-Pérez |
title |
Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report |
title_short |
Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report |
title_full |
Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report |
title_fullStr |
Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report |
title_full_unstemmed |
Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report |
title_sort |
delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report |
publisher |
BMC |
series |
BMC Neurology |
issn |
1471-2377 |
publishDate |
2020-06-01 |
description |
Abstract Background Partially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm. Case presentation We performed a proximal surgical basilar artery occlusion on a 64-year-old female with a partially thrombosed giant BA aneurysm. MRI showed no ischemic lesions but showed marked edema adjacent to the aneurysm. She had a good recovery, but 3 months after surgical occlusion, her gait deteriorated together with urinary incontinence and worsening right hemiparesis. MRI showed that the aneurysm had grown and developed intramural hemorrhage, which caused extensive brain edema and obstructive hydrocephalus. She was treated by a ventriculoperitoneal shunt placement. Follow-up MRI showed progressive brain edema resolution, complete thrombosis of the lumen and shrinkage of the aneurysm. At 5 years follow-up the patient had an excellent functional outcome. Conclusions Delayed growth of a surgically treated and thrombosed giant aneurysm from wall dissection demonstrates that discontinuity with the initial parent artery does not always prevent progressive enlargement. The development of transmural vascular connections between the intraluminal thrombus and adventitial neovascularization by the vasa vasorum on the apex of the BA seems to be a key event in delayed aneurysm growth. Extensive brain edema might translate an inflammatory edematous reaction to an abrupt enlargement of the aneurysm. |
topic |
Basilar apex aneurysm Hunterian occlusion Brain edema |
url |
http://link.springer.com/article/10.1186/s12883-020-01819-9 |
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