Selective endovascular techniques in the treatment of cerebral mycotic aneurysms

Report of three cases

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  • 1 Departments of Interventional Neuroangiography and Neurology, Lariboisière Hospital, Paris University, Paris, France: and Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
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✓ The aim of this study was to evaluate the role of endovascular treatment for intracranial mycotic aneurysms. The clinical and angiographic features of three patients with endocarditic vegetation (two with Streptococcus viridans and one with Staphylococcus) were reviewed retrospectively. Patients were selected for this treatment according to the clinical setting and aneurysm location. In two cases, selective catheterization of a distal middle cerebral and posterior cerebral artery branch with a microcatheter followed by superselective amobarbital testing of the parent vessel was preliminary to the occlusion of that vessel with autologous clot or glue. The third patient was treated by selective occlusion of the aneurysm by intra-aneurysmal placement of platinum minicoils. Two patients presented with intracranial hemorrhage and in one the lesion was found on computerized tomography. All three aneurysms had been excluded from the circulation at the 6-month follow-up review. The only complication from the procedure, despite the septic nature and distal localization, was balloon deflation in one patient, who was successfully retreated with coils. Endovascular embolization is indicated in patients who are at risk of hemorrhage and cannot undergo the standard procedure. The superselective amobarbital test allows selection of patients who will tolerate distal vessel occlusion. This endovascular procedure represents a safe and effective treatment for these lesions.

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  • 1.

    Bamford J, , Hodges J, & Warlow C: Late rupture of a mycotic aneurysm after “cure” of bacterial endocarditis. J Neurol 233:5153, 1986 Bamford J, Hodges J, Warlow C: Late rupture of a mycotic aneurysm after “cure” of bacterial endocarditis. J Neurol 233:51–53, 1986

    • Search Google Scholar
    • Export Citation
  • 2.

    Bingham WF: Treatment of mycotic intracranial aneurysms. J Neurosurg 46:428437, 1977 Bingham WF: Treatment of mycotic intracranial aneurysms. J Neurosurg 46:428–437, 1977

    • Search Google Scholar
    • Export Citation
  • 3.

    Brust JCM, , Dickinson PCT, & Hughes JEO, et al: The diagnosis and treatment of cerebral mycotic aneurysms. Ann Neurol 27:238246, 1990 Brust JCM, Dickinson PCT, Hughes JEO, et al: The diagnosis and treatment of cerebral mycotic aneurysms. Ann Neurol 27:238–246, 1990

    • Search Google Scholar
    • Export Citation
  • 4.

    Frazee JG, , Cahan LD, & Winter J: Bacterial intracranial aneurysms. J Neurosurg 53:633641, 1980 Frazee JG, Cahan LD, Winter J: Bacterial intracranial aneurysms. J Neurosurg 53:633–641, 1980

    • Search Google Scholar
    • Export Citation
  • 5.

    Hadley MN, , Spetzler RF, & Martin NA, et al: Middle cerebral artery aneurysm due to Nocardia asteroides: case report of aneurysm excision and extracranial-intracranial bypass. Neurosurgery 22:923928, 1988 Hadley MN, Spetzler RF, Martin NA, et al: Middle cerebral artery aneurysm due to Nocardia asteroides: case report of aneurysm excision and extracranial-intracranial bypass. Neurosurgery 22:923–928, 1988

    • Search Google Scholar
    • Export Citation
  • 6.

    Hart RG, , Kagan-Hallet K, & Joerns SE: Mechanisms of intracranial hemorrhage in infective endocarditis. Stroke 18:10481056, 1987 Hart RG, Kagan-Hallet K, Joerns SE: Mechanisms of intracranial hemorrhage in infective endocarditis. Stroke 18:1048–1056, 1987

    • Search Google Scholar
    • Export Citation
  • 7.

    Higashida RT, , Halbach VV, & Barnwell SL, et al: Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR 11:633640, 1990 Higashida RT, Halbach VV, Barnwell SL, et al: Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR 11:633–640, 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    Hilal SK, & Solomon RA: Endovascular treatment of aneurysms with coils. J Neurosurg 76:337338, 1992 (Letter) Hilal SK, Solomon RA: Endovascular treatment of aneurysms with coils. J Neurosurg 76:337–338, 1992 (Letter)

    • Search Google Scholar
    • Export Citation
  • 9.

    Micheli F, , Schteinschnaider A, & Plaghos LL, et al: Bacterial cavernous sinus aneurysm treated by detachable balloon technique. Stroke 20:17511754, 1989 Micheli F, Schteinschnaider A, Plaghos LL, et al: Bacterial cavernous sinus aneurysm treated by detachable balloon technique. Stroke 20:1751–1754, 1989

    • Search Google Scholar
    • Export Citation
  • 10.

    Ojemann RG: Surgical management of bacterial intracranial aneurysms, in Schmidek HH, & Sweet WH (eds): Operative Neurosurgical Techniques. Indications, Methods and Results, ed 2. Orlando: Grune & Stratton, 1988, Vol 2. pp 9971001 Ojemann RG: Surgical management of bacterial intracranial aneurysms, in Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques. Indications, Methods and Results, ed 2. Orlando: Grune & Stratton, 1988, Vol 2. pp 997–1001

    • Search Google Scholar
    • Export Citation
  • 11.

    Salgado AV, , Furlan AJ, & Keys TF: Mycotic aneurysm, subarachnoid hemorrhage, and indications for cerebral angiography in infective endocarditis. Stroke 18:10571060, 1987 Salgado AV, Furlan AJ, Keys TF: Mycotic aneurysm, subarachnoid hemorrhage, and indications for cerebral angiography in infective endocarditis. Stroke 18:1057–1060, 1987

    • Search Google Scholar
    • Export Citation
  • 12.

    Salgado AV, , Furlan AJ, & Keys TF, et al: Neurologic complications of endocarditis: a 12-year experience. Neurology 39:173178, 1989 Salgado AV, Furlan AJ, Keys TF, et al: Neurologic complications of endocarditis: a 12-year experience. Neurology 39:173–178, 1989

    • Search Google Scholar
    • Export Citation
  • 13.

    Stilhart B, , Aboulker J, & Khouadja F, et al: Faut-il rechercher et opérer les anévrismes de la maladie d'Osler avant l'hémorragie? Neurochirurgie 32:410417, 1986 Stilhart B, Aboulker J, Khouadja F, et al: Faut-il rechercher et opérer les anévrismes de la maladie d'Osler avant l'hémorragie? Neurochirurgie 32:410–417, 1986

    • Search Google Scholar
    • Export Citation

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