J Cerebrovasc Endovasc Neurosurg.  2016 Dec;18(4):379-384. 10.7461/jcen.2016.18.4.379.

Serpentine Cavernous Aneurysm Presented with Visual Symptoms Improved by Endovascular Coil Trapping

• Oh MJ
• Shin DS
• Se R
• Kim BT

• KMID: 2367330
• DOI: http://doi.org/10.7461/jcen.2016.18.4.379

Abstract

This report describes a case of a serpentine fusiform aneurysm of the internal carotid artery in a patient who presented with visual disturbances. The serpentine aneurysm was treated successfully by coil trapping and occlusion of the parent artery, accompanied by balloon dilation. Nine months post-operatively, the patient's visual acuity had improved considerably.

Keyword

Internal carotid artery; Fusiform aneurysm; Visual acuity

MeSH Terms

Aneurysm*
Arteries
Carotid Artery, Internal
Humans
Parents
Visual Acuity

Figure

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  Fig. 1 (A) MRI shows a large thrombosed aneurysm 19 × 12 mm in size, well marginated, and oval-shaped, with a heterogeneous signal void in the right parasellar region, probably in the cavernous sinus. (B) CTA shows a fusiform dilatation of the right cavernous ICA, suggestive of a fusiform aneurysm approximately 30 × 20 mm in size. MRI = magnetic resonance imaging; CTA = computed tomography angiography; ICA = internal carotid artery.

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  Fig. 2 Fundus photography shows right optic nerve atrophy, with a pale neural rim on the right optic disc.

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  Fig. 3 3D angiography shows a large serpentine aneurysm of the right ICA 11.72 × 22.49 mm in size. 3D = three-dimensional; ICA = internal carotid artery.

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  Fig. 4 (A, B) Matas test performed on the right ICA using balloon dilation of the parent artery followed by observation of the patient for 20 min. (C) SPECT shows the well-maintained vascular reserve. (D, E-1, E-2) Collateral flow from the left ICA & vertebrobasilar system was well visualized on preoperative cerebral angiography. ICA = internal carotid artery; SPECT = single-photon emission computed tomography.

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  Fig. 5 (A-D) Coil embolization with occlusion of the parent artery using balloon dilation was performed using detachable and pushable coils.

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  Fig. 6 (A, B) The visual field defect improved 9 months after coil embolization of the aneurysm.

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