Pipeline Embolization of an Infectious Basilar Artery Aneurysm in a 2-Year-Old Child: Case Report, Discussion of the Literature and Perioperative Considerations.
Aneurysm, Infected
/ diagnostic imaging
Angiography, Digital Subtraction
Anti-Bacterial Agents
/ therapeutic use
Anticoagulants
/ therapeutic use
Basilar Artery
Cerebral Angiography
Child, Preschool
Computed Tomography Angiography
Embolization, Therapeutic
/ instrumentation
Endocarditis, Bacterial
/ complications
Humans
Hypoplastic Left Heart Syndrome
/ complications
Intracranial Aneurysm
/ diagnostic imaging
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Subarachnoid Hemorrhage
/ diagnostic imaging
Vasospasm, Intracranial
/ diagnostic imaging
Flow diversion
Infections aneurysm
Intracranial aneurysm
Mycotic aneurysm
Pediatric aneurysm
Subarachnoid hemorrhage
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 11 2019
01 11 2019
Historique:
received:
27
08
2019
accepted:
11
01
2019
pubmed:
29
1
2019
medline:
7
10
2020
entrez:
29
1
2019
Statut:
ppublish
Résumé
Flow diversion of intracranial aneurysms has been rarely described in the pediatric population. Here we discuss the technical and perioperative complexities inherent in the flow diversion of an infectious basilar apex aneurysm in a 2-yr-old child with significant medical comorbidities. Following judicious oral administration of dual anti-platelet agents and intra-arterial administration of calcium channel blockers to treat vasospasm, standard endovascular procedures were used to place a flow diverting stent across the neck of a rapidly enlarging infectious aneurysm of the basilar apex.Following the uncomplicated procedure, the patient demonstrated progressive thrombosis of the previously noted basilar apex aneurysm over a 3-mo period. The patient was therefore felt to be safe to proceed with, and eventually underwent, uncomplicated orthotopic heart transplant. Flow diversion of complex intracranial aneurysms in pediatric patients with significant medical comorbidities is feasible and safe; however, considerations have to be made in the pre- and perioperative care of these patients given the propensity for low-weight and complicated systemic disease processes.
Sections du résumé
BACKGROUND AND IMPORTANCE
Flow diversion of intracranial aneurysms has been rarely described in the pediatric population. Here we discuss the technical and perioperative complexities inherent in the flow diversion of an infectious basilar apex aneurysm in a 2-yr-old child with significant medical comorbidities.
CLINICAL PRESENTATION
Following judicious oral administration of dual anti-platelet agents and intra-arterial administration of calcium channel blockers to treat vasospasm, standard endovascular procedures were used to place a flow diverting stent across the neck of a rapidly enlarging infectious aneurysm of the basilar apex.Following the uncomplicated procedure, the patient demonstrated progressive thrombosis of the previously noted basilar apex aneurysm over a 3-mo period. The patient was therefore felt to be safe to proceed with, and eventually underwent, uncomplicated orthotopic heart transplant.
CONCLUSION
Flow diversion of complex intracranial aneurysms in pediatric patients with significant medical comorbidities is feasible and safe; however, considerations have to be made in the pre- and perioperative care of these patients given the propensity for low-weight and complicated systemic disease processes.
Identifiants
pubmed: 30690548
pii: 5299244
doi: 10.1093/ons/opz002
doi:
Substances chimiques
Anti-Bacterial Agents
0
Anticoagulants
0
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
E224-E228Informations de copyright
Copyright © 2019 by the Congress of Neurological Surgeons.