Endovascular treatment of intracranial infectious aneurysms
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Date
2016
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Abstract
Introduction: Intracranial infectious aneurysm (IIA) accounts for less than 5 % of all intracranial aneurysms. The aim of this study was to evaluate the role of endovascular treatment for IIA. Methods: During a 14-year period, 15 patients (age range, 2–68 years; mean, 42.8 years) with 17 aneurysms were diagnosed with IIA and treated via an endovascular route at our institution. The IIA diagnosis was based on clinical and laboratory findings of infection, echocardiography results, and digital subtraction angiography that were collected retrospectively. All patients were clinically and radiologically followed. The modified Rankin scale was used to evaluate clinical outcome. Results: Among 15 patients, 12 presented with ruptured aneurysms (7 intraparenchymal hematoma, 4 subarachnoid hemorrhage, 1 subdural hematoma), 2 with cerebral infarcts, and 1 with pansinusitis and epidural abscess. All but one aneurysm were distally located in intracranial circulation, 14 were in anterior, and the remaining 3 were in posterior circulation. The final diagnosis was based on aneurysm morphology, location, and clinical laboratory findings. Endovascular treatment was scheduled initially for all IIAs; 13 of 17 IIAs underwent endovascular parent vessel occlusion, 3 underwent spontaneous parent vessel occlusion while waiting for intervention, and the remaining patient was treated by intrasaccular coil occlusion. There were no instances of perioperative neurological complications. Late clinical and radiological outcomes included absence of endovascular treatment related to mortality and aneurysm recurrence. Conclusion: Endovascular treatment may be performed safely at the time of diagnosis for at least symptomatic IIAs under the protective effect of antibiotic treatment. © 2015, Springer-Verlag Berlin Heidelberg.
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Keywords
Adult , Aged , Aneurysm, Infected , Anti-Bacterial Agents , Cerebral Angiography , Child , Child, Preschool , Combined Modality Therapy , Embolization, Therapeutic , Endovascular Procedures , Hemostatics , Humans , Intracranial Aneurysm , Male , Middle Aged , Treatment Outcome , antibiotic agent , C reactive protein , antiinfective agent , hemostatic agent , adult , aged , aneurysm rupture , antibiotic therapy , Article , artificial embolism , brain hemorrhage , brain infarction , brain infection , child , clinical article , clinical laboratory , computed tomographic angiography , computed tomography scanner , controlled study , craniotomy , digital subtraction angiography , echocardiography , echography , endovascular aneurysm repair , epidural abscess , erythrocyte sedimentation rate , female , follow up , human , intracranial aneurysm , intracranial infectious aneurysm , intraparenchymal hematoma , male , middle aged , nuclear magnetic resonance imaging , nuclear magnetic resonance scanner , preschool child , priority journal , Rankin scale , retrospective study , risk factor , school child , sinusitis , subarachnoid hemorrhage , subdural hematoma , treatment duration , Aneurysm, Infected , artificial embolization , brain angiography , case report , complication , diagnostic imaging , endovascular surgery , intracranial aneurysm , multimodality cancer therapy , procedures , treatment outcome