Endovascular Treatment of Patients with Oculomotor Nerve Palsy Induced by Posterior Communicating Artery Aneurysms.

Objective: Whether coiling is the best treatment option for oculomotor nerve palsy (ONP) induced by posterior communicating artery (PComA) aneurysms remains controversial. In this study, we retrospectively analyzed the recovery of ONP caused by PComA aneurysms. Methods: Between 2007 and 2019, 8 patients with PComA aneurysms and ONP underwent coiling at our institution. We retrospectively reviewed ONP recovery, duration from onset of ONP to treatment, and complications of procedures. Results: At the last available clinical follow-up, ONP recovery was complete in 4 patients (50%) and partial in 4 patients (50%). Patients with partial recovery of ONP had sequelae of eye movement impairment that did not affect daily life. In 1 patient, hemiplegia developed due to cerebral infarction of the corona radiata the day after coiling, but it fully recovered 1 year after operation. The delay from the onset of ONP to coiling was significantly related to partial ONP recovery (r = -0.83, p = 0.01). Conclusion: Endovascular treatment is a relatively safe and satisfactory treatment for PComA aneurysms with ONP.

[A Case of Brainstem Hemorrhage Following Embolization of a Large Basilar Aneurysm with Hydrogel-Coated Coils].

OBJECTIVE: Endovascular coil embolization of intracranial aneurysms is associated with better outcomes and a lower mortality rate compared with surgical clip occlusion. However, a principal disadvantage of endovascular therapy is the higher rate of retreatment compared with neurosurgical clipping. Self-expandable hydrogel-coated coils were developed to reduce recanalization rates of cerebral aneurysms by promoting complete volumetric aneurysm occlusion. Herein, we report a case of brainstem hemorrhage following coil embolization of a large basilar aneurysm with hydrogel-coated coils. CASE PRESENTATION: A 65-year-old female with a history of hypertension, who presented with worsening headaches, right hemiplegia, and left oculomotor palsy, underwent endovascular treatment for a large basilar aneurysm. The aneurysm was treated with both hydrogel-coated coils and bare platinum coils. Hydrogel-coated coils represented 46% of the coil length in the aneurysm. The patient was discharged from the hospital with improvement of neurological deficits 6 days after the procedure. However, the patient was readmitted with perianeurysmal edema in the midbrain 23 days after coil embolization. Follow-up angiography 26 days after the procedure showed complete obliteration of the aneurysm. Two weeks later, the patient presented with a large brainstem hemorrhage and died. Pathological findings revealed intraparenchymal hemorrhage in the pons without rupture of the aneurysm. CONCLUSION: Hydrogel-coated coils may cause a marked inflammatory response that may result in intracerebral hemorrhage.

[Case of a giant cervical carotid artery aneurysm with contralateral severe stenosis treated using a covered stent].

We report a case of a cervical carotid artery pseudoaneurysm with contralateral severe stenosis, treated using a covered stent. A 79-year-old man admitted for a splenic artery aneurysm presented a pulsatile mass on the right side of his neck and lower cranial nerve palsy after misinsertion of a central venous line into the right carotid artery. MRI revealed a huge thrombosed aneurysm (30 mm×25 mm) in the right common carotid artery (CCA). We planned an aneurysmectomy and CCA interposition with a vascular graft. However the aneurysm continued to expand. We considered that it was difficult to expose the internal carotid artery (ICA) by a direct surgical technique, and therefore carried out placement of a covered stent over the orifice of the aneurysm using an endovascular surgical technique. Following placement of the covered stent, subsequent contrast-enhanced CT revealed leakage of contrast material into the aneurysm. An additional bare stent was placed into the proximal end of the covered stent at 15 days after the initial treatment. Angiography demonstrated no leakage of the contrast material. Following the second treatment, the pulsatile mass was reduced in size. Lower cranial nerve palsy remained but had slightly improved. We described the case of a huge cervical carotid pseudoaneurysm that was successfully treated using a covered stent.