Recanalization of Completely Thrombosed Non-Giant Saccular Aneurysm Mimicking asDe NovoAneurysm

Abstract

J Korean Neurosurg Soc 48 : [354][355][356] 2010 Partial thrombosis of giant aneurysms is not uncommon however, complete angiographic occlusion occurs less frequently. In the case of non-giant aneurysms, complete thrombosis and recanalization has been rarely reported. A 31-year-old man presented to the emergency department with sudden bursting headache. Brain computed tomography (CT) revealed diffuse subarachnoid hemorrhage on the left side. Both CT angiography (CTA) and digital subtraction angiography showed suspicion of small left anterior choroidal artery aneurysm. We performed surgical exploration. In the operation field, anterior choroidal artery aneurysm of 2×2 mm with broad neck and friable appearance was observed. Because we could not clip without sacrificing the anterior choroidal artery, we performed wrapping only. Follow up CTA after 7 months demonstrated 4 mm right internal carotid artery bifurcation aneurysm. The patient underwent aneurismal neck clipping. During the operation, 9 ×13 mm sized thrombosed aneurysm was detected and completely clipped. We initially thought this aneurysm to be a de novo aneurysm however, it was an aneurysm that had recanalized from a completely thrombosed aneurysm. This case report provides an insight into the potential for complete thrombosis and recanalization of non-giant aneurysms.

Spontaneous Occluded Anterior Communicating Artery Aneurysm during Coil Embolization Treated with One Coil Insertion into Remaining Stump

“… 14) Although the pathophysiology of spontaneous recanalization has not been fully elucidated, recanalization ensuing from complete thrombosis of aneurysms has been reported in many studies. 4) 5) 11) 12) 16) 19) 21) 22) In these studies, recanalization of acute thrombosis of the aneurysm was observed in the days and weeks after thrombosis. Therefore, follow-up angiogram and careful observation during the follow-up period are required for fear of recanalization resulting in rebleeding of the aneurysm.…”

Delayed Rebleeding of Cerebral Aneurysm Misdiagnosed as Traumatic Subarachnoid Hemorrhage

“…The incidence of angiogram negative SAH is approximately 9-30% and 10% of repeat angiograms detect hidden aneurysms inducing SAH 1). The causes of angiogram negative SAH include thrombosed aneurysm, local vasospasm, parenchymal bleeding around an aneurysm, and high intracranial pressure 2). In this case, the authors suspected that thrombosis of the aneurysm occurred by hemostatic homeostasis after rupture to prevent further bleeding.…”

“…In this case, the authors suspected that thrombosis of the aneurysm occurred by hemostatic homeostasis after rupture to prevent further bleeding. Statistically 13-20% of giant aneurysms and 1-2% of non-giant aneurysms can be thrombosed, and the factors associated with thrombosis are a small aneurysmal neck, intraluminal thrombosis, and aneurysm age 2). The other possibility is focal vasospasm of the aneurysmal neck after rupture.…”

“…SAH induces vasospasm of the parent artery or aneurysmal neck, so hemodynamic change can occur in the aneurysmal sac or neck. Lastly, the aneurysmal orifice can be temporarily occluded, and blood flow to the aneurysmal sac is blocked 2)8)…”