Endovascular Treatment of Cerebral Artery Aneurysms during Pregnancy: Report of Three Cases
Philip M. Meyers
,a,
Van V. Halbacha,
Adel M. Maleka,
Constantine C. Phatourosa,
Christopher F. Dowda,
Michael T. Lawtona,
Todd E. Lemperta and
Randall T. Higashidaa
a From the Departments of Radiology (P.M.M., V.V.H., A.M.M., C.P.P., C.F.D., T.E.L., R.T.H.) and Neurosurgery (V.V.H., C.F.D., M.T.L., R.T.H.), University of California at San Francisco.
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FIG 1. A–K, 34-year old woman with severe headache and a right third cranial nerve palsy.
A, Brain CT scan shows focal hemorrhage surrounding the aneurysm (arrow) in the right prepontine cistern.
B and C, Cerebral arteriogram during left vertebral artery injection shows a fusiform aneurysm (arrows) arising from the proximal right PCA. Note that there is no filling during right carotid artery injection.
D and E, After clipping, there is no filling of the aneurysm from either the vertebral or carotid injections. The surgical clip is denoted by straight arrows. Note continued opacification of the distal right PCA (curved arrow, E), presumably supplied by the posterior communicating artery. Continued 
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FIG 1 (continued). F–K, 17 weeks after surgical clipping, the patient presented with recurrent headaches and a right third nerve palsy. Brain CT scans (F and G) show interval aneurysm growth from 16 mm to 21 mm (arrows) despite prior surgical clipping of the proximal right P1 PCA segment. Cerebral arteriograms (H and I) show renewed opacification of the aneurysm (arrows) via posterior communicating artery to a greater degree than the PCA. Cerebral arteriograms after GDC coiling procedure (J and K) now show complete occlusion of the aneurysm and improved visualization of the distal right PCA
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FIG 2. A, 36-year-old woman with severe headache and grade II subarachnoid hemorrhage from a ruptured 7-mm basilar terminus aneurysm (long arrow). Note the presence also of a 1.4-mm left superior cerebellar artery aneurysm (short arrow).
B, Complete obliteration is achieved after GDC occlusion of the basilar terminus aneurysm (arrows). The patient was followed up closely for the small, unruptured superior cerebellar artery aneurysm.
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FIG 3. A, 36-year-old woman with severe headache and a grade I subarachnoid hemorrhage from a ruptured posterior communicating artery aneurysm (arrow).
B, Postembolization angiogram after GDC occlusion shows complete obliteration of the aneurysm (arrow).
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