Treatment of Traumatic Internal Carotid Artery Aneurysm by Flow-Diverter: A Single-Center Experience

Elsevier

Available online 23 August 2022

NeurochirurgieAbstractAim

Traumatic intracranial aneurysm (TICA) is a rare vascular lesion with various etiologies and a high mortality rate when diagnosed late. In this study, we present our cases of TICA, which we treated with flow-diverter stents due to different etiological factors.

Methods

Clinical data were recorded for 8 patients: age, gender, etiological factors, aneurysm location, aneurysm type, rupture, main artery status, and postoperative complications.

Results

75% (n:6) of the patients were male and 25% (n:2) female. Etiologically, there was intracranial tumor surgery in 3 cases (37.5%), fall from height in 2 (25%), road accident in 2 (25%), and blunt trauma in 1 (12.5%). Reconstruction used a flow-diverting stent in all cases. One patient experienced intraoperative iatrogenic rupture of the distal arterioles due to a microwire. Mean angiographic follow-up was 17.8 months (range, 6-32 months). During follow-up, none of the patients required renewed endovascular treatment.

Conclusion

Traumatic aneurysm is a vascular lesion with high mortality when diagnosed late. In case of suspected vascular injury after trauma or intracranial surgery, further evaluation should be performed without delay. TICA can be safely treated with flow-diverter stents, conserving the main artery.

Section snippetsAbbreviationsACA

anterior cerebral artery

BA

basilar artery

CT

computed tomography

DSA

digital Subtraction Angiography

FD

flow-diverter

ICA

internal carotid artery

ICH

intracerebral hemorrhage

MCA

middle cerebral artery

MRI

magnetic resonance imaging

SAH

subarachnoid hemorrhage

TICA

traumatic intracranial aneurysm

Material and methods

Local ethics committee approval was received for the study (January 28, 2020/59).

Results

Eight aneurysms were treated. All cases were associated with trauma or previous intracranial surgery. 75% (n:6) of the patients were male and 25% (n:2) female. Mean age was 34.3 years (range, 13-61 years).

All trauma cases had a Glasgow Coma Scale (GCS) score of ≥12. In addition, subarachnoid hemorrhage or intraparenchymal hematoma in the intracranial area was detected in all cases except case no 1.

Etiologically, 3 cases (37.5%) developed after intracranial tumor surgery, 2 (25%) after a fall

Case no 1

A 29-year-old male patient presented to the emergency department after a 5-meter fall. Multiple skull base fractures were detected on brain CT, but no surgical intervention was performed. The patient returned to the emergency department with a complaint of epistaxis on the 15th day after the trauma. He was treated with an FD stent. The patient was discharged with normal neurological status after 2 days’ follow-up (Fig. 1, Fig. 2).

Case no 2

A 13-year-old male patient had a history of pterional craniotomy

Discussion

The normal mechanisms and pathophysiology of aneurysm in the intracranial space are now generally known. Traumatic intracranial aneurysms (TICAs) are aneurysms that occur outside the normal context of aneurysm formation pathophysiology and etiology, with etiologies including trauma, skull-base surgery, transsphenoidal surgery, sinus surgery, ventricular puncture, endoscopic third ventriculostomy (ETV), and external ventricular drainage (EVD) for intracranial pressure monitoring [[5], [6], [9],

Conclusion

Traumatic aneurysms are vascular lesions with high mortality when diagnosed late. Detailed examination of the vascular anatomy in vascular events such as subarachnoid hemorrhage or intraparenchymal hemorrhage in etiologies accompanied by skull base fracture facilitates the detection of traumatic aneurysm. In addition, in cases requiring reoperation after tumor surgery, vascular structures should be examined in detail on preoperative MR angiography or CT angiography. TICA can be safely treated

Disclosure of interest

The authors declare that they have no competing interest.

Funding

This study was not supported by any foundation or company.

Ethics approval

Approval for this retrospective study was obtained for the study from a local ethics committee (28.01.2020/59).

Author contributions

Adem Doğan: Design, Investigation; Gökhan Yüce, Mehmet Ozan Durmaz: Methodology; Adem Doğan, Mehmet Ozan Durmaz: Data curation; Adem Doğan: Writing, Original draft preparation; Adem Doğan, Mehmet Can Ezgü: Imaging review; Mehmet Ozan Durmaz: Supervision. Gökhan Yüce: Software; Adem Doğan: Reviewing and Editing.

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