Endovascular obliteration of an intracranial pseudoaneurysm: the utility of Onyx

Technical note

Restricted access

Pseudoaneurysms are rare lesions with a multitude of causes, including infectious, traumatic, and iatrogenic origins. In addition, there are a number of potential treatment options, all of which require consideration to determine the most appropriate management. Historically, surgical intervention has been the method of choice, but because the histopathological features of these lesions make them largely unsuitable for clipping, trapping or excision is often required. More recently endovascular methods have been used, including coil embolization, stent reconstruction, or parent artery occlusion. Although these methods are often successful, situations arise in which they are not technically feasible. The authors describe such a case in a pediatric patient with an iatrogenic pseudoaneurysm. Onyx was used to embolize the lesion and the results were excellent.

Abbreviations used in this paper: ACA = anterior cerebral artery; ICA = internal carotid artery.
Article Information

Contributor Notes

Address correspondence to: Aaron S. Dumont, M.D., Department of Neurological Surgery, University of Virginia Health System, Box 800212, Charlottesville, Virginia 22908. email:asd2f@virginia.edu.

© Copyright 1944-2019 American Association of Neurological Surgeons

Headings
References
  • 1

    Amirjamshidi ARahmat HAbbassioun K: Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occurring during war: principles and pitfalls in diagnosis and management. A survey of 31 cases and review of the literature. J Neurosurg 84:7697801996

    • Search Google Scholar
    • Export Citation
  • 2

    Blankenship BABaxter ABMcKahn GM II: Delayed cerebral artery pseudoaneurysm after nail gun injury. AJR Am J Roentgenol 172:5415421999

    • Search Google Scholar
    • Export Citation
  • 3

    Cantasdemir MKantarci FMihmanli INuman F: Embolization of profunda femoris artery branch pseudoaneurysms with ethylene vinyl alcohol copolymer (onyx). J Vasc Interv Radiol 13:7257282002

    • Search Google Scholar
    • Export Citation
  • 4

    Cekirge HSSaatci IOzturk MHCil BArat AMawad M: Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience. Neuroradiology 48:1131262006

    • Search Google Scholar
    • Export Citation
  • 5

    Charbel FTGonzales-Portillo GHoffman WCochran E: Distal internal carotid artery pseudoaneurysms: technique and pitfalls of surgical management: two technical case reports. Neurosurgery 45:6436491999

    • Search Google Scholar
    • Export Citation
  • 6

    Cohen JERajz GItshayek EShoshan YUmansky FGomori JM: Endovascular management of traumatic and iatrogenic aneurysms of the pericallosal artery. Report of two cases. J Neurosurg 102:5555572005

    • Search Google Scholar
    • Export Citation
  • 7

    Eddleman CSSurdell DDiPatri A JrTomita TShaibani A: Infectious intracranial aneurysms in the pediatric population: endovascular treatment with Onyx. Childs Nerv Syst 24:9099152008

    • Search Google Scholar
    • Export Citation
  • 8

    Fiorella DAlbuquerque FCDeshmukh VRWoo HHRasmussen PAMasaryk TJ: Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:2913002006

    • Search Google Scholar
    • Export Citation
  • 9

    Horowitz MAlbright ALJungreis CLevy EIStevenson K: Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report. Neurosurgery 49:146114652001

    • Search Google Scholar
    • Export Citation
  • 10

    Larson PSReisner AMorassutti DJAbdulhadi BHarpring JE: Traumatic intracranial aneurysms. Neurosurg Focus 8:1e42000

  • 11

    Le HMunshi IMacdonald RLWollmann RFrank J: Traumatic aneurysm resulting from insertion of an intracranial pressure monitor. Case illustration. J Neurosurg 95:7202001

    • Search Google Scholar
    • Export Citation
  • 12

    Lempert TEHalbach VVHigashida RTDowd CFUrwin RWBalousek PA: Endovascular treatment of pseudoaneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 19:9079111998

    • Search Google Scholar
    • Export Citation
  • 13

    Levine NBTanaka TJones BVCrone KR: Minimally invasive management of a traumatic artery aneurysm resulting from shaken baby syndrome. Pediatr Neurosurg 40:1281312004

    • Search Google Scholar
    • Export Citation
  • 14

    Molyneux AJCekirge SSaatci IGal G: Cerebral Aneurysm Multicenter European Onyx (CAMEO) trial: results of a prospective observational study in 20 European centers. AJNR Am J Neuroradiol 25:39512004

    • Search Google Scholar
    • Export Citation
  • 15

    Murayama YVinuela FTateshima SVinuela F JrAkiba Y: Endovascular treatment of experimental aneurysms by use of a combination of liquid embolic agents and protective devices. AJNR Am J Neuroradiol 21:172617352000

    • Search Google Scholar
    • Export Citation
  • 16

    Shirane RKondo TYoshida YKFuruta SYoshimoto T: Ruptured cerebral pseudoaneurysm caused by the removal of a ventricular catheter. Case report. J Neurosurg 91:103110331999

    • Search Google Scholar
    • Export Citation
  • 17

    Sim SYShin YSYoon SH: Endovascular internal trapping of traumatic pericallosal pseudoaneurysm with hydrogel-coated self-expandable coil in a child: a case report. Surg Neurol 69:4184222008

    • Search Google Scholar
    • Export Citation
  • 18

    Sure UBecker RPetermeyer MBertalanffy H: Aneurysm of the posterior inferior cerebellar artery caused by a traumatic perforating artery tear-out mechanism in a child. Childs Nerv Syst 15:3543561999

    • Search Google Scholar
    • Export Citation
  • 19

    Tokunaga KKusaka NNakashima HDate IOhmoto T: Coil embolization of intradural pseudoaneurysms caused by arterial injury during surgery: report of two cases. AJNR Am J Neuroradiol 22:35392001

    • Search Google Scholar
    • Export Citation
  • 20

    Uzan MCantasdemir MSeckin MSHanci MKocer NSarioglu AC: Traumatic intracranial carotid tree aneurysms. Neurosurgery 43:131413221998

    • Search Google Scholar
    • Export Citation
  • 21

    Vanninen RLManninen I: Onyx, a new liquid embolic material for peripheral interventions: preliminary experience in aneurysm, pseudoaneurysm, and pulmonary arteriovenous malformation embolization. Cardiovasc Intervent Radiol 30:1962002007

    • Search Google Scholar
    • Export Citation
  • 22

    Weber WSiekmann RKis BKuehne D: Treatment and follow-up of 22 unruptured wide-necked intracranial aneurysms of the internal carotid artery with Onyx HD 500. AJNR Am J Neuroradiol 26:190919152005

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 202 193 38
Full Text Views 54 32 0
PDF Downloads 120 53 1
EPUB Downloads 0 0 0
PubMed
Google Scholar