Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: Open surgical bailout with STA-MCA bypass and parent vessel occlusion - Case report

Adib A. Abla, Hasan A. Zaidi, R. Webster Crowley, Gavin W. Britz, Cameron G. McDougall, Felipe C.A. Albuquerque, Robert F. Spetzler

Research output: Contribution to journalArticlepeer-review

Abstract

Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery-middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm. Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED.

Original languageEnglish (US)
Pages (from-to)31-37
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume14
Issue number1
DOIs
StatePublished - Jul 2014
Externally publishedYes

Keywords

  • Aneurysm
  • Bypass
  • Chiasmopathy
  • Optic chiasm
  • Parent vessel occlusion
  • Parry-Romberg syndrome
  • Pipeline Embolization Device
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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