Giant serpentine aneurysm of the internal cerebral artery and mandibular aneurysm: a case report

Abstract

Background: Giant serpentine aneurysms (GSA) originate from saccular or spindle aneurysm, dissimilar from dissected aneurysm, that are defined as partially thrombosed giant aneurysms with tortuous internal vascular channel. The clinical and neuroradiologic characteristics are clarified and the mechanism of formation and the efficacy of double stent implantation in GSA are discussed. Case presentation: An 18-year-old man presented himself with a GSA arising from the internal cerebral artery (ICA). In addition, a mandibular aneurysm (MA) arose from the external cerebral artery (ECA). Success was achieved in treating GSA through endovascular treatment with double stents implanted in the parent artery, which were LEO stent and Tubridge flow diverter. After 1 year of follow-up, three-dimensional reconstruction of blood vessels revealed the disappearance of the serpentine access of GSA, which was found to be replaced with a roughly normal vascular structure. Conclusions: Double stent implantation has provided a feasible treatment option for giant serpentine internal carotid aneurysms and eliminated the possibility of causing collateral circulation occlusion. Therefore, it represents a simple and suitable treatment method for anatomical structure and operation.

Flow diversion treatment for giant intracranial serpentine aneurysms

“…In previous studies, surgical resection was typically used to treat GSAs ( Xu et al, 2016 ). Recently, endovascular occlusion has been successful in treating GSAs ( Oh et al, 2016 ; Kandemirli et al, 2018 ; Deng and Feng, 2019 ; Dao et al, 2021 ; Mizuno et al, 2021 ; Civlan et al, 2022 ). Kandemirli et al reported 15 patients from three centers who underwent aneurysm and parent artery occlusion with coiling or balloon, and improvement or resolution of symptoms without any treatment-related morbidity was achieved in 11 patients ( Kandemirli et al, 2018 ).…”

“…In previous studies, treatment options for GSA were limited and included direct resection with or without revascularization and bypass combined with occlusion of the inflow or outflow pathways. Endovascular treatments, such as balloon or coiling occlusion of the parent artery, have been reported as alternative options to GSA treatment ( Oh et al, 2016 ; Kandemirli et al, 2018 ; Deng and Feng, 2019 ; Dao et al, 2021 ; Mizuno et al, 2021 ; Civlan et al, 2022 ). However, simply occluding the GSA without ensuing adequate circulation to the distal brain parenchyma may not be consistent with the pathological characteristics of GSA, especially in the blood vessels that supply blood to critical areas of the brain.…”

“…More recently, flow diversion (FD) devices, such as the Pipeline Embolization Device (PED; Medtronic, Minneapolis, Minnesota, United States) or the Tubridge Embolization Device (TED; MicroPort NeuroTech, Shanghai, China), have been used to treat complex and giant aneurysms ( Deng and Feng, 2019 ). Theoretically, compared with direct resection or coiling/balloon parent artery occlusion, FD devices can reconstruct the vessels included in GSA lesions, thus maintaining distal circulation.…”