PMC7457645_01
Left: Anterior-posterior digital subtraction angiography of the right ICA
before treatment. The aneurysm develops medially into the sellar region and
measures 25 mm. After interdisciplinary discussion, endovascular treatment
was recommended and performed with application of 24 coils (Penumbra 400)
with assistance of a self-expanding stent (Neuroform EZ, 4.5 x 20). Right:
Control series at the end of the first intervention.
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Final control showed complete occlusion of the aneurysm; no residual inflow could be detected (Figure 1).
Magnetic resonance imaging on postinterventional day 7. The mass effect of
the aneurysm compromises all structures in proximity to the sella turcica.
Note the strong inflammatory signal close to the left oculomotor nerve and
the pituitary stalk, as well as around the whole wall of the aneurysm. Top:
Coronal contrast enhanced T1 sequence of the sellar region. A: giant
aneurysm of the right ICA after occlusion, I: left ICA, C: optic chiasm, S:
pituitary stalk, P: pituitary, O: left oculomotor nerve in the wall of the
cavernous sinus, *: inflammatory signal. Bottom: Axial T2 sequence of the
sellar region. A: giant aneurysm of the right ICA after occlusion, I: left
ICA, B: head of the basilar artery, O: left oculomotor nerve, *:
inflammatory signal.
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MRI on postinterventional day 7 did not detect subarachnoid hemorrhage or increased compression of neural structures, but revealed inflammatory signals in the aneurysm wall with contact to the pituitary stalk and the left oculomotor nerve (Figure 2).
Anterior-posterior digital subtraction angiography of the right ICA 42 months
after first treatment. In addition to the first intervention, 25 platinum
coils (Penumbra 400) and three flow-diverting stents (Phenox p64, 3.5 x 15,
3.5 x 21 and 3.5 x 18) have been applied in three additional interventions.
In contrast to the first intervention, the subsequent steps went without
further complications.
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Consecutively, the aneurysm then was permanently occluded, as shown in the digital subtraction angiography from August 2017, 42 months after first treatment (Figure 3).