Elsevier

Surgical Neurology

Volume 69, Issue 6, June 2008, Pages 627-632
Surgical Neurology

Aneurysm
Perianeurysm edema with second-generation bioactive coils

https://doi.org/10.1016/j.surneu.2007.01.069Get rights and content

Abstract

Background

Perianeurysm edema is an uncommon complication of intracranial aneurysms, occurring mostly in giant aneurysms that suddenly thrombose.

Case Description

We present the first report of an unruptured, nongiant, saccular aneurysm that developed marked perianeurysm edema after embolization with Matrix2 coils. In this case, follow-up catheter angiography showed a new coil tail protruding beyond the dome of the aneurysm in the region of the most intense edema.

Conclusions

We postulate that perianeurysm edema may occur after breakdown of the aneurysm wall accompanied by an inflammatory response to exposed bioactive coils. Clinicians should be aware of this potential complication and consider performing earlier surveillance angiography when this occurs to ensure that there has not been a shift in the coil mass and recurrence of the aneurysm.

Introduction

Perianeurysm edema is a rare complication of intracranial aneurysms. It generally presents as an acute increase in mass effect. Most reports have associated it with sudden thrombosis of a giant aneurysm. It has been described, using either deconstructive or constructive approaches, to occur both spontaneously as well as after surgery and endovascular treatment [1], [3], [4], [5], [7], [9], [10], [11], [14], [15], [17], [18]. We present the first report of a nongiant saccular aneurysm embolized primarily with Matrix2 coils that developed marked perianeurysm edema. We also propose a new mechanism and its implications for management.

Section snippets

Case report

A 27-year-old woman presented with episodic headaches and vertigo over the course of a week. She had no other medical conditions and denied any personal or family history suggestive of aneurysm rupture. Magnetic resonance imaging and angiography was performed, revealing a left carotid terminus aneurysm without evidence for prior intracranial hemorrhage (Fig. 1A).

Catheter angiography demonstrated a 6 × 6 × 8 mm saccular aneurysm arising from the carotid artery terminus (Fig. 1B). No other

Discussion

Acute, perianeurysmal edema is a rarely reported and poorly understood syndrome. The diagnosis should be considered when signs and symptoms suggestive of local mass effect of an aneurysm develop, either with or without treatment. Typical presentations include hemiparesis [7], [9], visual deficits [11], aphasia [9], or seizures [15], [18]. Massive cerebral edema rarely occurs and may cause alteration in mental status, papilledema, Parinaud sign, herniation, or even death [9], [14]. Other

Conclusions

Perianeurysm edema is an uncommon complication of intracranial aneurysms. It has been reported predominantly in giant aneurysms and attributed to sudden thrombosis with or without treatment. We describe a rare case of an unruptured, nongiant, saccular aneurysm that developed marked, asymmetric perianeurysm edema after embolization with Matrix2 coils. We suspect that in this case the associated edema was due to a delayed microperforation or breakdown of the aneurysm wall and an intense tissue

References (18)

  • G.G. Ferguson et al.

    Carotid-ophthalmic aneurysms: visual abnormalities in 32 patients and the results of treatment

    Surg Neurol

    (1981)
  • S.W. Atlas et al.

    Partially thrombosed giant intracranial aneurysms: correlation of MR and pathologic findings

    Radiology

    (1987)
  • H.H. Batjer et al.

    Enlarging thrombosed aneurysm of the distal basilar artery

    Neurosurgery

    (1990)
  • C.G. Drake

    Giant intracranial aneurysms: experience with surgical treatment in 174 patients

    Clin Neurosurg

    (1979)
  • A.J. Fox et al.

    Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms

    J Neurosurg

    (1987)
  • V.V. Halbach et al.

    The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect

    J Neurosurg

    (1994)
  • D. Hammoud et al.

    Acute vasogenic edema induced by thrombosis of a giant intracranial aneurysm: a cause of pseudostroke after therapeutic occlusion of the parent vessel

    AJNR Am J Neuroradiol

    (2003)
  • S.T. Hecht et al.

    Growth of a thrombosed giant vertebral artery aneurysm after parent artery occlusion

    AJNR Am J Neuroradiol

    (1991)
  • R.C. Heros et al.

    Giant intracranial aneurysms presenting with massive cerebral edema

    Neurosurgery

    (1984)
There are more references available in the full text version of this article.

Cited by (10)

  • Perianeurysmal edema: Prevalence, risk factors and clinical significance

    2017, Journal of Neuroradiology
    Citation Excerpt :

    In the 9 patients with pre-existing PAE, we observed different evolution after EVT, in line with the proposed pathogenesis. PAE clinical significance appears varied with some detected incidentally as well as some displaying neurological symptoms [12–14,16–27]. In our series, five patients with PAE (25.0%) were symptomatic.

View all citing articles on Scopus
View full text