Treatment of giant cavernous aneurysm in an elderly patient via extracranial-intracranial saphenous vein bypass graft in a hybrid operating room: A case report.
|Abstract||Extracranial-intracranial saphenous vein bypass (EC-IC SVB) remains indispensable for treating giant cavernous aneurysms. We report an unusual case of a giant cavernous aneurysm in an elderly patient treated with EC-IC SVB in a hybrid operating room. Immediately following proximal ligation of the internal carotid artery (ICA), she suffered an acute intraoperative encephalocele.|
A case of bilateral giant internal carotid artery aneurysms at the cavernous portion managed by 2-stage extracranial-intracranial bypass with parent artery occlusion: consideration for bypass selection and timing of surgeries.
|Publication Year Start||2018-01-01|
PMID- 29620651 OWN - NLM STAT- MEDLINE DCOM- 20180416 LR - 20180416 IS - 1536-5964 (Electronic) IS - 0025-7974 (Linking) VI - 97 IP - 14 DP - 2018 Apr TI - Treatment of giant cavernous aneurysm in an elderly patient via extracranial-intracranial saphenous vein bypass graft in a hybrid operating room: A case report. PG - e0295 LID - 10.1097/MD.0000000000010295 [doi] AB - RATIONALE: Extracranial-intracranial saphenous vein bypass (EC-IC SVB) remains indispensable for treating giant cavernous aneurysms. We report an unusual case of a giant cavernous aneurysm in an elderly patient treated with EC-IC SVB in a hybrid operating room. Immediately following proximal ligation of the internal carotid artery (ICA), she suffered an acute intraoperative encephalocele. PATIENT CONCERNS: A 71-year-old woman had suffered from severe headache and double vision for 4 months. DIAGNOSES: The woman was diagnosed with a right giant cavernous aneurysm. INTERVENTIONS: She was treated with an EC-IC SVB with therapeutic ICA occlusion in the first biplane hybrid operating room in China. Just after proximal ligation of the ICA, she developed an acute encephalocele, and immediately underwent decompressive craniectomy. During the surgery she underwent 3 angiographic explorations. OUTCOMES: After surgery, the aneurysm disappeared, and the graft was patent. Postoperative computed tomography and computed tomography angiography indicated a cranial defect and graft patency. LESSONS: Although a hybrid operating room could improve the patency of grafts, the timing of ICA ligation for giant cavernous aneurysm via EC-IC bypass deserves further discussion. Second-stage ICA occlusion could offer an alternative for elderly patients requiring such treatment. In addition, cranial flap removal could prevent further neurologic deficits in a case of acute intraoperative encephalocele. FAU - Xin, Can AU - Xin C AD - Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China. FAU - Zhang, Jianjian AU - Zhang J FAU - Li, Zhengwei AU - Li Z FAU - Xiong, Zhongwei AU - Xiong Z FAU - Yang, Bangkun AU - Yang B FAU - Wu, Xiaolin AU - Wu X FAU - Wang, Hao AU - Wang H FAU - Zou, Yichun AU - Zou Y FAU - Wu, Rongqing AU - Wu R FAU - Zhao, Wenyuan AU - Zhao W FAU - Chen, Jincao AU - Chen J LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R SB - AIM SB - IM MH - Aged MH - Carotid Artery, Internal/*surgery MH - Cerebral Revascularization/adverse effects/*methods MH - Encephalocele/etiology MH - Female MH - Humans MH - Intracranial Aneurysm/pathology/*surgery MH - Intraoperative Complications/etiology MH - Ligation/methods MH - Operating Rooms MH - Saphenous Vein/*transplantation EDAT- 2018/04/06 06:00 MHDA- 2018/04/17 06:00 CRDT- 2018/04/06 06:00 PHST- 2018/04/06 06:00 [entrez] PHST- 2018/04/06 06:00 [pubmed] PHST- 2018/04/17 06:00 [medline] AID - 10.1097/MD.0000000000010295 [doi] AID - 00005792-201804060-00029 [pii] PST - ppublish SO - Medicine (Baltimore). 2018 Apr;97(14):e0295. doi: 10.1097/MD.0000000000010295.