Author(s) Paul E. Kaloostian, Han Chen^*, Howard Yonas

Affiliation(s)
Johns Hopkins University Medical Center, Baltimore, USA.
University of New Mexico Neurological Surgery, Albuquerque, USA.

ABSTRACT

Objective and Importance: The authors report a case of a symptomatic giant serpentine MCA aneurysm treated with double STA-MCA bypass with thrombectomy and excision of aneurysm. This is the first reported case of a double bypass with concomitant thrombectomy and excision of aneurysmal segment. Clinical Presentation/Methods: We report the case of a 27-year-old Hispanic male with severe acute decline in mental status with a giant serpentine MCA aneurysm with significant mass effect and midline shift trapping the lateral ventricular system. Intervention/Results: Patient presented initially to an outside hospital for altered mental status and confusion. Patient was diagnosed with a giant serpiginous aneurysm and hydrocephalus. A left ventriculoperitoneal shunt was placed at the outside hospital and patient was transferred to University of New Mexico. At this time, his mental status declined rather abruptly. He was treated with a double STA-MCA bypass procedure with aneurysm resection.

KEYWORDS
Double Bypass; STA-MCA; Serpentine; Aneurysm; Resection; Thrombectomy

Cite this paper
P. Kaloostian, H. Chen and H. Yonas, "Giant Serpentine Aneurysm Treated with Double EC-IC Bypass with Thrombectomy and Excision of Aneurysm: A Case Review and Technical Note," Open Journal of Modern Neurosurgery, Vol. 3 No. 3, 2013, pp. 29-32. doi: 10.4236/ojmn.2013.33006.

References
[1]   H. D. Segal and R. L. Mclaurin, “Giant Serpentine Aneurysm: Report of Two Cases,” Journal Neurosurgery, Vol. 46, No. 1, 1977, pp. 115-120. doi:/10.3171/jns.1977.46.1.0115

[2]   V. A. Aletich, G. M. Debrun, L. H. Monsein, H. J. Nauta and R. F. Spetzler, “Giant Serpetine Aneurysm: A Review and Presentation of Five Cases,” American Journal of Neuroradiology, Vol. 16, 1995, pp. 1601-1072.

[3]   L. D. Christiano, G. Gupta, C. J. Prestigiacomo and C. D. Gandhi, “Giant Serpentine Aneurysms,” Neurosurgical Focus, Vol. 26, No. 5, 2009, p. E5. doi:/10.3171/2009.2.FOCUS0918

[4]   R. R. Lukin, A. A. Chambers, R. McLaurin and J. Tew Jr., “Thrombosed Giant Middle Cerebral Aneurysms,” Neuroradiology, Vol. 10, No. 3, 1975, pp. 125-129. doi:/10.1007/BF00341812

[5]   A. Mahadevan, R. Tagore, N. M. Siddappa, V. Santosh, T. C. Yasha, U. Ranga, et al., “Giant Serpentine Aneurysm of Vertebrobasilar Artery Mimicking Dolichoectasia—An Unusual Complication of Pediatric AIDS. Report of a Case with Review of the Literature,” Clinical Neuropathology, Vol. 27, No. 1, 2008, pp. 37-52.

[6]   N. F. Fanning, M. O. Kelleher and D. Q. Ryder, “The Pretzel Sign: Angiographic Pattern of Tortuous Intra-Aneurysmal Blood Flow in a Giant Serpentine Aneurysm,” British Journal of Neurosurgery, Vol. 17, 2003, pp. 67-71.

[7]   M. B. Horowitz, H. Yonas, C. Jungreis and T. K. Hung, “Management of a Giant Middle Cerebral Artery Fusiform Serpentine Aneurysm with Distal Clip Application and Retrograde Thrombosis: Case Report and Review of the Literature,” Surgical Neurology, Vol. 41, No. 3, 1994, pp. 221-225. doi:/10.1016/0090-3019(94)90126-0

[8]   K. C. Lee, J. Y. Joo, K. S. Lee and Y. S. Shin, “Recanlization of Completely Thrombosed Giant Aneurysm: Case Report,” Surgical Neurology, Vol. 51, No. 1, 1999, pp. 94-98.

[9]   A. Sari, S. Kandemir, L. Kuzeyli and H. Dinc, “Giant Serpentine Aneurysm with Acute Spontaneous Complete Thrombosis,” American Journal of Neuroradiology, Vol. 27, 2006, pp. 766-768.

[10]   S. Suzuki, T. Takahashi, H. Ohkuma, T. Shimizu and S. Fujita, “Management of Giant Serpentine Aneurysms of the Middle Cererbral Artery: Review of Literature and Report of Case Successfully Treated by STA-MCA Anastomosis Only,” Acta Neurochirurgica, Vol. 117, No. 1-2, 1992, pp. 23-29. doi:/10.1007/BF01400630

[11]   M. Scott and E. Skwarok, “The Treatment of Cerebral Aneurysms by Ligation of the Commone Carotid Artery,” Surgery Gynecology & Obstetrics, Vol. 113, 1961, pp. 54-61.

[12]   S. Amin-Hanjani, P. R. Chen, S. W. Chang and R. F. Spetzler, “Long Term Follow up of Giant Serpentine MCA Aneurysm Treated with EC-IC Bypass and Proximal Occlusion,” Acta Neurochirurgica, Vol. 148, No. 2, 2006, pp. 227-228. doi:/10.1007/s00701-005-0691-3

[13]   W. J. Van Rooij, M. Sluzewski and G. N. Beute, “Endovascular Treatment of Giant Serpentine Aneurysms,” American Journal of Neuroradiology, Vol. 29, 2008, pp. 1418-1419. doi:/10.3174/ajnr.A1071