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- Title
AT THE EDGE OF THE CRANIUM: CASE REPORT OF AN UNRUPTURED C1-C2 INTERNAL CAROTID ANEURISM AND LITERATURE REVIEW.
- Authors
Filimon, Robert-Alexandru; Vazar-Tripon, Daiana-Andreea; Muntean, Maria-Miruna; Florian, Ioan Stefan
- Abstract
Introduction: Aneurysms of the C1-C2 segments are considered extracranial, based on Bouthillier's classification. ICA aneurysms mostly occur intracranialy, thus the lession of our patient is rare. Aneurysms can be treated by microsurgical clipping or endovascular techinques. In the case of our patient, that is awaiting a medical decision, the endovascular is the most likely to be chosen. Case Report: The patient, a 34 y.o. male, presented to our clinic for vertigo, nausea and tinnitus in the right ear. The tinnitus began 7 years prior to admission. On examination, the patient was aware (GCS=15) and presented no motor deficits. An angio-MRI was performed and showed a saccular aneurysm of the C1-C2 segments of the ICA and a filiform V4 segment of the vertebral artery, most probably constitutinal. The patient was kept under supervision until the proper treatment was chosen, the endovascular approach being the most probable, given the nature and location of the lession. Discussions : Unruptured aneurysm can be treated via clipping, if they have an aneurysmal sack smaller than 25 mm and have a small enaough neck. The aneurysm of our patient would be eligible for clipping, having a diameter of 7 mm, but the localization in the C1-C2 segments poses a high risk of arterial dissection, that could lead to thrombembolism and stroke. In the case of extracranial ICA aneurysms, the literature stipulates that up to 87% of patients treated via endovascular approach completely recover neurologicaly. Based on this, endovascular techiques are being considered as treatment. Simple coilling as opposed to coiling and stenting has a higher risk of occlusion, leading to a high risk of ischemic stroke. Another option being considered is the use of a flow-diverter device. The literature shows a 84.4% rate of complete aneurysmal occlusion with under 5% complications, such as ischemic stoke. The flow-diverter is usually used for complex cases, such as our patient, that has a high risk of ischemic stoke due to the constitutionaly filiform vertebral artey. A disadvantage of performing endovascular techiques is the use of antiplatelet medication, that increases the risk of intraoperative or postoperative hemorrage. Conclusions: In conclusion, a multidisciplinary team is needed in order to choose the proper treatment for some types of aneurysms, such as our case. Extracranial ICA aneurysms have a better prognostic if they are treated endovasculary. Further studies are needed in order to properly understand the potential downsides of the endovascular treatment of extracranial ICA aneurysms.
- Subjects
ROMANIA; CAROTID artery; ANEURYSMS; ENDOVASCULAR aneurysm repair; CONFERENCES &; conventions; SURGICAL complications; PLATELET aggregation inhibitors; HEMORRHAGE
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p148
- ISSN
2668-7755
- Publication type
Article