Delayed Hydrocephalus after Combined Treatment with Pipeline Embolization Device and Platinum Coil for Large Unruptured Intracranial Aneurysm: A Report of Two Cases

抄録

Objective: Pipeline Embolization Device (PED; Medtronic, Minneapolis, NM, USA) is the first and currently only flow diversion device approved by the Ministry of Health, Labour and Welfare in Japan. The PED is able to embolize the unruptured intracranial aneurysm (UIA) due to the disruption of blood flow into the aneurysm sac while preserving the normal blood flow of parent and surrounding branch vessels. One of the drawbacks of PED embolization is to require the coil embolization when the aneurysms are deemed to be high-risk delayed aneurysm rupture.

Case Presentations: We report two cases suffered from delayed hydrocephalus after combined treatment with PED and platinum coil for large UIAs. Both patients had an improvement of symptoms related to delayed hydrocephalus after lumboperitoneal shunts (LPS). Gadolinium (Gd)-diethylenetriamine penta-acetic acid (DTPA)-enhanced magnetic resonance (MR) images before the LPS showed the aneurysm wall enhancement, suggesting the inflammation of aneurysm wall. The examinations of cerebral spinal fluid (CSF) sampled during the LPS procedures showed the high protein level without elevated cells/decreased glucose, suggesting aseptic meningitis. The aneurysm wall inflammation and aseptic meningitis were thought be main causes of the delayed hydrocephalus.

Conclusion: In this case report, we warn that combined treatment with PED and platinum coil has the risk of delayed hydrocephalus.