Case of endovascular treatment of a patient with fusiform aneurysm de novo m2-branch of the middle brain artery

Abstract

A clinical case with the choice of an individual strategy and tactics of endovascular treatment of a patient with fusiform aneurysm de novo of a branch of the middle cerebral artery is considered. Diagnosis and treatment was carried out in Scientific-practical Center of endovascular neuroradiology of the National Academy of Medical Sciences of Ukraine. Patient B., born in 1996, was admitted to the center in the acute period of hemorrhage from the fusiform aneurysm of the M2-branch of the middle cerebral artery, which, in turn, was excluded from circulation deconstructive, without neurological deficit in the postoperative period. Three months after the first endovascular treatment the patient was re-admitted to the center with the clinical manifestations of spontaneous subarachnoid hemorrhage. According to multispiral computed tomography and selective cerebral angiography, a fusiform aneurysm de novo of M2-branch of the middle cerebral artery was found, which, in turn, was excluded from circulation deconstructive in two stages. The first attempt at endovascular treatment failed to achieve total fusiform aneurysm de novo occlusion using detachable coils, due to the high risk of intraoperative complications. Ten days after the first stage the patient was taken again. Non-standard technique using balloon-assisted adhesive composition made it possible to achieve complete deconstructive occlusion of fusiform aneurysm de novo from the blood stream and to avoid complications in the form of neurological deficit. The postoperative period proceeded without features. In satisfactory condition the patient discharged under the supervision of a neurologist at the place of residence. The patient underwent 4 control examinations in the form of selective cerebral angiography. Collateral blood flow to the branches of the middle cerebral artery is preserved.

Keywords

• multiple aneurysms; cerebral angiography; fusiform aneurysm; neurosurgery; middle cerebral artery; hemorrhage; endovascular treatment.