Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 915-918
DOI: 10.4103/ajns.AJNS_58_19
Case Report

Onyx embolization of distal middle cerebral artery aneurysm in a patient with nontraumatic subdural hematoma

Nida Fatima
Department of Neurosurgery, Hamad General Hospital, Doha
,
Ghanem Al Sulaiti
Department of Neurosurgery, Hamad General Hospital, Doha
,
Ghaya Al Rumaihi
Department of Neurosurgery, Hamad General Hospital, Doha
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Distal cortical middle cerebral artery (MCA) aneurysm is a rare entity. Despite the challenging procedure, the role of endovascular treatment is emerging due to its safety and efficacy in obliterating the microaneurysm. We report a 25-year-old male, who presented with a history of dizziness and headache for almost 2 weeks. Computed tomography scan showed a right front parietal subdural hematoma (SDH). We could not identify any underlying defining etiology of SDH neither head injury nor coagulopathy disorder. Therefore, diagnostic cerebral angiogram was performed, which showed a microaneurysm in the distal right MCA cortical branch. Hence, complete obliteration of this microaneurysm was performed using Onyx for endovascular embolization. Therefore, this case report demonstrates the efficacy of this modality in the treatment of microaneurysms with SDH.

Key-words:

Endovascular treatment - microaneurysm - subdural hematoma

Financial support and sponsorship

By the Asian Journal of Neurosurgery, and Medical Research Council, Hamad Medical Corporation.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Lee SM, Park HS, Choi JH, Huh JT. Ruptured mycotic aneurysm of the distal middle cerebral artery manifesting as subacute subdural hematoma. J Cerebrovasc Endovasc Neurosurg 2013;15:235-40.
  • 2 Baltacioǧlu F, Cekirge S, Saatci I, Oztürk H, Arat A, Pamir N. Distal middle cerebral artery aneurysms. Endovascular treatment results with literature review. Interv Neuroradiol 2002;8:399-407.
  • 3 Lee SH, Bang JS. Distal middle cerebral artery M4 aneurysm surgery using navigation-CT angiography. J Korean Neurosurg Soc 2007;42:478-80.
  • 4 Kocak A, Ates O, Durak A, Alkan A, Cayli S, Sarac K, et al. Acute subdural hematomas caused by ruptured aneurysms: Experience from a single Turkish center. Turk Neurosurg 2009;19:333-7.
  • 5 Mrfka M, Pistracher K, Augustin M, Kurschel-Lackner S, Mokry M. Acute subdural hematoma without subarachnoid hemorrhage or intraparenchymal hematoma caused by rupture of a posterior communicating artery aneurysm: Case report and review of the literature. J Emerg Med 2013;44:e369-73.
  • 6 Ishibashi A, Yokokura Y, Sakamoto M. Acute subdural hematoma without subarachnoid hemorrhage due to ruptured intracranial aneurysm – Case report. Neurol Med Chir (Tokyo) 1997;37:533-7.
  • 7 Raza SM, Papadimitriou K, Gandhi D, Radvany M, Olivi A, Huang J. Intra-arterial intraoperative computed tomography angiography guided navigation: A new technique for localization of vascular pathology. Neurosurgery 2012;71:ons240-52.
  • 8 Gross BA, Du R. STA-MCA bypass. Acta Neurochir (Wien) 2012;154:1463-7.
  • 9 Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FP, Kamerman JD. Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg 2005;103:982-9.
  • 10 Suzuki K, Kodama N, Sasaki T, Matsumoto M, Ichikawa T, Munakata R. Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery. J Neurosurg 2007;107:68-73.
  • 11 Lv N, Zhou Y, Yang P, Li Q, Zhao R, Fang Y, et al. Endovascular treatment of distal middle cerebral artery aneurysms: Report of eight cases and literature review. Interv Neuroradiol 2016;22:12-7.
  • 12 Chalouhi N, Tjoumakaris S, Gonzalez LF, Hasan D, Alkhalili K, Dumont AS, et al. Endovascular treatment of distal intracranial aneurysms with onyx 18/34. Clin Neurol Neurosurg 2013;115:2528-32.
  • 13 Utoh J, Miyauchi Y, Goto H, Obayashi H, Hirata T. Endovascular approach for an intracranial mycotic aneurysm associated with infective endocarditis. J Thorac Cardiovasc Surg 1995;110:557-9.
  • 14 Feliciano CE, de León-Berra R, Hernández-Gaitán MS, Torres HM, Creagh O, Rodríguez-Mercado R, et al. Provocative test with propofol: Experience in patients with cerebral arteriovenous malformations who underwent neuroendovascular procedures. AJNR Am J Neuroradiol 2010;31:470-5.
  • 15 Kurdi M, Baeesa S, Bin-Mahfoodh M, Kurdi K. Onyx embolization of ruptured intracranial aneurysm associated with behçet's disease. Case Rep Vasc Med 2013;2013:797045.
  • 16 Lee CY. Embolization with NBCA for ruptured aneurysm located in the moyamoya-like collateral network associated with isolated middle cerebral artery occlusion. Asian J Neurosurg 2018;13:1236-8.
  • 17 Lee JY, Kim MK, Cho BM, Park SH, Oh SM. Surgical experience of the ruptured distal anterior cerebral artery aneurysms. J Korean Neurosurg Soc 2007;42:281-5.