J Cerebrovasc Endovasc Neurosurg.  2022 Mar;24(1):51-57. 10.7461/jcen.2022.E2021.06.003.

Endovascular occlusion of giant serpentine aneurysm: A case report and literature review

• Civlan S
• Yakar F
• Coskun ME
• Sato K

• KMID: 2527595
• DOI: http://doi.org/10.7461/jcen.2022.E2021.06.003

Abstract

Giant serpentine aneurysms (GSAs) are a rare subgroup of intracranial aneurysms. Separate inflow and outflow flow due to intraluminal thrombosis is the most distinguishing feature of GSAs. In treating these lesions, surgical clipping and ligation were the main treatments in the past, but bypass for revascularisation and endovascular therapies (EVTs) for deconstructive purposes are more prominent today. A 51-years-old male patient presented with headache and mild right hemiparesis. He had a GSA arising from the left fetal type posterior cerebral artery (fPCA) that was out of follow-up for six years. Radiological images revealed midline shifting and mesencephalon compression. We performed endovascular parent artery coil occlusion. The symptoms of the patient improved at the first-month follow-up. Even if there is a mass effect in GSAs, deconstructive EVT is a safe and feasible method for managing these lesions.

Keyword

Giant serpentine aneurysm; Endovascular therapy; Occlusion; Coil embolization

Figure

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  Fig. 1. Six years ago, the axial images of contrast-enhanced MRI revealed a thrombosed aneurysm arising from fPCA (A-C). On angiography (D), the serpentine aneurysm that was arising from fPCA appeared. MRI, magnetic resonance imagination; fPCA, fetal posterior cerebral artery.

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  Fig. 2. Serpentine aneurysm with calcified areas and perilesional oedema were observed in axial CT. (A) Contrast-enhanced MRI revealed aneurysm, and mesencephalon compression on axial images (B), perilesional oedema on sagittal images (C, D), and midline shift on coronal (E, F) images. On DSA, anteroposterior (G) and lateral (H) view of an enlarged GSA observed compared to the previous six years. CT, computed tomography; MRI, magnetic resonance imagination; DSA, digital subtraction angiography; GSA, giant serpentine aneurysm.

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  Fig. 3. The GSA and intraluminal thrombosis were illustrated in the left temporal region (A). During endovascular therapy, the aneurysm was catheterised with a microwire (B), and imaging was performed with a microcatheter. (C) After the stable coil frame was made (D), it was observed that the aneurysm was totally occluded (E). The fPCA was also patent at the end of the procedure. GSA, giant serpentine aneurysm; fPCA, fetal posterior cerebral artery; PCoA, posterior communicating artery; MCA, middle cerebral artery.

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  Fig. 4. There was no complication related to the procedure on immediate CT (A), and one month later, MRI showed that the aneurysm was occluded (B). Perilesional oedema (C) and midline shift (D) were regressed. CT, computed tomography; MRI, magnetic resonance imagination.

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