Neurosurgery practice · 2025
Combined Pipeline Embolization and Coiling of an Intracranial Aneurysm in Marfan Syndrome: A Case Report and Literature Review.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Grin Eric A, Nossek Erez, Sharashidze Vera, Raz Eytan, Shapiro Maksim, Riina Howard A
Аннотация
BACKGROUND AND IMPORTANCE: Marfan syndrome's association with intracranial aneurysms, though controversial, poses unique challenges for surgical intervention because of the inherent vascular fragility. Open surgical approaches carry considerable risk. Endovascular flow diversion with the Pipeline embolization device (PED) offers a less invasive alternative, and adjunctive coiling can decrease occlusion time for complex aneurysms. We report the first combined use of PED and coiling to treat a Marfan-associated intracranial aneurysm, detailing our operative approach and reviewing the literature.
CLINICAL PRESENTATION: A 53-year-old patient with a pathological FBN1 mutation was incidentally found to have an unruptured paraophthalmic aneurysm during stroke workup. Diagnostic angiography revealed an irregular superior hypophyseal aneurysm along with tortuous and irregular internal carotid arteries suggesting previous dissections. The aneurysm was successfully treated with a PED and adjunctive coil embolization. The patient was discharged on aspirin and clopidogrel. Six-month follow-up angiography confirmed aneurysm occlusion. Although there was no residual or recurrent aneurysm at 2-year follow-up, imaging revealed 2 de novo intracranial aneurysms. The patient remains asymptomatic and under observation.
CONCLUSION: This is the first case of combined PED and coiling for an intracranial aneurysm in Marfan syndrome. This dual approach may offer safer and more effective treatment than traditional methods. In addition, the formation of de novo aneurysms underscores the importance of long-term angiographic follow-up in patients with FBN1 mutations to monitor for evolving vascular pathology. These findings warrant further investigation into identifying a genetic link between FBN1 mutations and cerebrovascular pathology.
CLINICAL PRESENTATION: A 53-year-old patient with a pathological FBN1 mutation was incidentally found to have an unruptured paraophthalmic aneurysm during stroke workup. Diagnostic angiography revealed an irregular superior hypophyseal aneurysm along with tortuous and irregular internal carotid arteries suggesting previous dissections. The aneurysm was successfully treated with a PED and adjunctive coil embolization. The patient was discharged on aspirin and clopidogrel. Six-month follow-up angiography confirmed aneurysm occlusion. Although there was no residual or recurrent aneurysm at 2-year follow-up, imaging revealed 2 de novo intracranial aneurysms. The patient remains asymptomatic and under observation.
CONCLUSION: This is the first case of combined PED and coiling for an intracranial aneurysm in Marfan syndrome. This dual approach may offer safer and more effective treatment than traditional methods. In addition, the formation of de novo aneurysms underscores the importance of long-term angiographic follow-up in patients with FBN1 mutations to monitor for evolving vascular pathology. These findings warrant further investigation into identifying a genetic link between FBN1 mutations and cerebrovascular pathology.