Traumatic Intracranial Aneurysms Treated by Intra-aneurysmal Coil Embolization

Abstract

Objective: We describe a rare case of traumatic ophthalmic artery and basilar artery aneurysms treated by pure intra-aneurysmal coil embolization without any complication, although aneurysmal recanalization occurred and also re-embolization was necessary. Traumatic basilar artery aneurysm is quite rare.Case Presentations: In this case, parent arteries of above aneurysms had no tolerance for cerebral blood flow in occlusion state, as shown by balloon occlusion tests. Additionally, these parent arteries had a high degree of operative difficulty with artery bypass, because of their anatomical locations. Thus, we decided to perform purely intra-aneurysmal coil embolizations. Careful procedures were required to prevent intra-procedural aneurysm rupture and recanalization, because the wall of the traumatic aneurysm is very fragile, similar to a pseudo-aneurysm. To prevent intra-procedural aneurysm rupture, a soft coil with variable diameter loops was choiced as the framing coil. Close follow-up by angiography at 1-to 3-week intervals was performed for earlier recognition of recanalization. Respectively, these aneurysms required only one additional coil embolization for recanalization caused by coil compaction. In sub-acute phase, maturation of the surrounding fibrous aneurysm wall might occur, and it reduced the potential for recanalization.Conclusion: If problems of intra-procedural aneurysm rupture and recanalization can be avoided, pure intra-aneurysmal coil embolization will be a suitable treatment for traumatic intracranial aneurysm. We recommend use of a soft coil as the framing coil and close follow-up with angiography until the subacute phase is reached.