Successful Endovascular Treatment of A Ruptured Mycotic Intracavernous Carotid Artery Aneurysm in an AIDS Patient

Wang, Huan; Rammos, Stylianos K.; Fraser, Kenneth; Elwood, Patrick W.

doi:10.1007/s12028-007-0072-2

Cited by 18 publications

(23 citation statements)

References 23 publications

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“…There are also reports of successful endovascular vessel sacrifice for the treatment of mycotic aneurysms in patients who passed a balloon occlusion test. 30 In our patient, however, we believed that the risk profile favored surgery and that surgery would give us the best chance at clip reconstruction of the basilar trunk while sparing the right AICA.…”

Section: Discussionmentioning

confidence: 77%

Clipping of a Mycotic Basilar Trunk Aneurysm under Cardiac Arrest in a Pregnant AIDS Patient

et al. 2010

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We present the first case of a coccidioidomycosis mycotic anterior inferior cerebellar artery (AICA) aneurysm that was clipped under hypothermic cardiac standstill in a pregnant acquired immunodeficiency syndrome (AIDS) patient. A 24-year-old pregnant AIDS patient presented with intraventricular hemorrhage and hydrocephalus. Angiography revealed an 8-mm basilar trunk aneurysm with the right AICA protruding from the side wall of the aneurysm. The patient underwent a retrosigmoid craniotomy and direct clipping of the aneurysm under hypothermic cardiac standstill. At presentation, the patient had a poor grade due to subarachnoid and intraventricular hemorrhage. Despite her large posterior circulation aneurysm in the setting of AIDS with extensive coccidioidomycosis meningitis, the lesion was clipped successfully. To do so required the full range of neurosurgical repertoire, including a skull base approach and hypothermic cardiac standstill.

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Section: Discussionmentioning

confidence: 77%

Clipping of a Mycotic Basilar Trunk Aneurysm under Cardiac Arrest in a Pregnant AIDS Patient

et al. 2010

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“…After screening of the titles and abstracts, 63 studies were selected for full review [1,3,4,7,10,11,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71]. Thirty studies with 2 or more patients and 33 case reports with a total number of 814 patients were identified.…”

Section: Resultsmentioning

confidence: 99%

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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Objective: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. Methods: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database. We undertook a comprehensive literature search using the OVID gateway of the MEDLINE database (1950-October 2015) using the following keywords (in combination): ‘infectious', ‘mycotic', ‘cerebral aneurysm', ‘intracranial aneurysm'. 1,721 potentially relevant abstracts were identified and 63 studies were selected for full review. The studies were analysed regarding ruptured versus unruptured aneurysms, aneurysm localization and treatment, as well as clinical and radiological outcome. Results: Our institutional series consisted of 6 patients (median age 57 [32-76]) treated between 2011 and 2015. All patients presented with ruptured IIAs located on the middle cerebral artery (MCA, 5 patients) and anterior cerebral artery (ACA, 1 patient). Five patients were treated by clipping and resecting the aneurysm, 1 patient underwent coiling. All patients received antibiotic therapy and 1 patient died. We further identified 814 patients (median age 35.5 [0-81]) in 63 studies. Locations of the aneurysms were mentioned in 55 studies. The most frequent locations of the aneurysms were: MCA (63.5%), posterior cerebral artery (14%), ACA (9.0%) and others (13.5%). Treatment for IIAs was described in 62 studies: antibiotic treatment (56.1%), a combination of antibiotics and surgery (20.9%) or antibiotics and endovascular treatment (23.0%). Outcome was mentioned in 82.4% of the patients with a mortality rate of 16.8%. An evaluation of treatment outcome was limited due to the heterogeneity of patients in the published case series. Conclusion: Antibiotic therapy of patients with IIA is mandatory. However, due to the complexity of the disease and its accompanying comorbidities, a general treatment algorithm could not be defined. Analogous to non-mycotic aneurysms, further treatment decisions require an interdisciplinary approach involving neurosurgeons, interventionists and infectious disease specialists.

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“…Indeed, nearly all of the individuals in our series had a history of advanced HIV with multiple AIDS-OIs and died without ever receiving effective ART (Tables 3 and 4). As such, AIDS-related morbidity undoubtedly contributed to the high mortality rate in our series and could likely have been reduced with effective ART [6, 12, 16, 17, 30, 34, 41, 43]. …”

Section: Discussionmentioning

confidence: 99%

Invasive Aspergillus Sinusitis in Human Immunodeficiency Virus Infection: Case Report and Review of the Literature

Humphrey

Walsh

Gulick

2016

Open Forum Infectious Diseases

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Invasive Aspergillus (IA) sinusitis is a life-threatening opportunistic infection in immunocompromised individuals, but it is uncommon in human immunodeficiency virus (HIV) infection. To gain a better understanding of the characteristics of IA sinusitis in this population, we present a unique case of chronic IA sinusitis in an HIV-infected patient taking antiretroviral therapy and review the literature summarizing published cases of invasive aspergillosis of the paranasal (n = 41) and mastoid (n = 17) sinuses in HIV-infected individuals. Among these cases, only 4 were reported after 1999, and 98% of patients had acquired immune deficiency syndrome. Orbital invasion occurred in 54% of paranasal sinus cases, whereas intracranial invasion was reported in 53% of mastoid sinus cases. The overall mortality was 79%. We also discuss various clinical and immunologic factors that may play a role in the development of IA and consider the changing epidemiology of aspergillosis in the era of effective antiretroviral therapy.

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Successful Endovascular Treatment of A Ruptured Mycotic Intracavernous Carotid Artery Aneurysm in an AIDS Patient

Cited by 18 publications

References 23 publications

Clipping of a Mycotic Basilar Trunk Aneurysm under Cardiac Arrest in a Pregnant AIDS Patient

Clipping of a Mycotic Basilar Trunk Aneurysm under Cardiac Arrest in a Pregnant AIDS Patient

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Invasive Aspergillus Sinusitis in Human Immunodeficiency Virus Infection: Case Report and Review of the Literature

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