International Journal of Neurosurgery
Volume 3, Issue 1, June 2019, Pages: 9-12
Received: Jun. 23, 2019;
Accepted: Aug. 4, 2019;
Published: Aug. 19, 2019
Views 241 Downloads 50
Mehrnoush Gorjian, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Scott Raymond, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Matthew Koch, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Aman Patel, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Flow diversion is an endovascular technique for embolization of intracranial aneurysms using a semi-porous stent to that redirects blood flow away from the aneurysm and is a scaffold for vessel remodeling. With flow diversion, aneurysms close slowly over 6-12 months as endothelial growth into the stent covers the neck of the aneurysm. Flow diversion is the preferred treatment for unruptured, large, paraclinoid aneurysms, which are otherwise challenging to treat with conventional open surgical or endovascular techniques. Post-embolization perianeurysmal edema (PAE) is an uncommon complication that occurs weeks to months after embolization and manifests as brain parenchymal edema surrounding the treated aneurysm. The clinical presentation is varied and includes headache, seizure or focal neurologic deficit. Frequently, PAE is misdiagnosed as an embolic stroke, which is a more common post-embolization complication and has some clinical and imaging overlap. PAE can be differentiated from ischemia by the absence of restricted diffusion and aneurysm wall enhancement on post-contrast Magnetic Resonance Imaging (MRI). PAE was initially described following coil embolization, but has subsequently been observed after flow diversion alone or with adjunctive coiling. Post-embolization PAE presumably results from rapid aneurysm thrombosis, endothelial cell necrosis, and the ensuing inflammatory reaction, which spreads to the adjacent brain parenchyma. Early recognition of PAE is critical to initiate appropriate therapy.
Perianeurysmal Edema After Embolization with Flow Diversion, International Journal of Neurosurgery.
Vol. 3, No. 1,
2019, pp. 9-12.
Walcott BP, Stapleton CJ, Choudhri O, Patel AB. Flow Diversion for the Treatment of Intracranial Aneurysms. JAMA Neurol. 2016 Aug 1; 73 (8): 1002-8. doi: 10.1001/jamaneurol.2016.0609.
Chalouhi N, Daou B, Barros G, Starke RM, Chitale A, Ghobrial G, Dalyai R, Hasan D, Gonzalez LF, Tjoumakaris S, Rosenwasser RH, Jabbour P. Matched Comparison of Flow Diversion and Coiling in Small, Noncomplex Intracranial Aneurysms. Neurosurgery. 2017 Jul 1; 81 (1): 92-97. doi: 10.1093/neuros/nyw070.
Chalouhi N, Tjoumakaris S, Starke RM, Gonzalez LF, Randazzo C, Hasan D, McMahon JF, Singhal S, Moukarzel LA, Dumont AS, Rosenwasser R, Jabbour P. Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke. 2013 Aug; 44 (8): 2150-4. doi: 10.1161/STROKEAHA.113.001785. Epub 2013 May 30.
Burrows AM, Cloft H, Kallmes DF, Lanzino G. Periprocedural and mid-term technical and clinical events after flow diversion for intracranial aneurysms. J Neurointerv Surg. 2015 Sep; 7 (9): 646-51. doi: 10.1136/neurintsurg-2014-011184. Epub 2014 Jul 31.
Shapiro, M., Ollenschleger, M. D., Baccin, C. E., Becske, T., Spiegel, G. R., Wang, Y., Song, X., Raz, E., Zumofen, D. W., Potts, M., Nelson, P. K. "Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features." American journal of neuroradiology 36.11 (2015): 2121-6.
Craven I, Patel UJ, Gibson A, Coley SC. Symptomatic Perianeurysmal Edema Following Bare Platinum Embolization of a Small Unruptured Cerebral Aneurysm. Am J Neuroradiol. 2009; 30 (10): 1998-2000. doi: 10.3174/ajnr.A1643.
Fanning NF, Willinsky RA, terBrugge KG. Wall enhancement, edema, and hydrocephalus after endovascular coil occlusion of intradural cerebral aneurysms. J Neurosurg. 2008; 108 (6): 1074-1086. doi: 10.3171/JNS/2008/108/6/1074.
Berge J, Tourdias T, Moreau J-F, Barreau X, Dousset V. Perianeurysmal Brain Inflammation after Flow-Diversion Treatment: Figure 1. Am J Neuroradiol. 2011; 32 (10): 1930-1934. doi: 10.3174/ajnr.A2710.
Vu Dang L, Aggour M, Thiriaux A, Kadziolka K, Pierot L. Post-embolization perianeurysmal edema revealed by temporal lobe epilepsy in a case of unruptured internal carotid artery aneurysm treated with bare platinum coils. J Neuroradiol. 2009. doi: 10.1016/j.neurad.2009.07.006.
Cohen JE, Itshayek E, Attia M, Moscovici S. Postembolization perianeurysmal edema as a cause of uncinate seizures. J Clin Neurosci. 2012. doi: 10.1016/j.jocn.2011.08.008.
Al-Mufti F, Amuluru K, Gandhi CD, Prestigiacomo CJ. Flow Diversion for Intracranial Aneurysm Management: A New Standard of Care. Neurotherapeutics. 2016. doi: 10.1007/s13311-016-0436-4.
Su I-C, Willinsky RA, Fanning NF, Agid R. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms. Neuroradiology. 2014; 56 (6): 487-495. doi: 10.1007/s00234-014-1355-x.
Heros RC, Kolluri S. Giant intracranial aneurysms presenting with massive cerebral edema. Neurosurgery. 1984. doi: 10.1227/00006123-198410000-00020.
Rouchaud A, Brinjikji W, Lanzino G, Cloft HJ, Kadirvel R, Kallmes DF. Delayed hemorrhagic complications after flow diversion for intracranial aneurysms: a literature overview. Neuroradiology. 2016; 58 (2): 171-177. doi: 10.1007/s00234-015-1615-4.
Lukic S, Jankovic S, Popovic KS, Bankovic D, Popovic P, Mijailovic M. Analysis of risk factors for perifocal oedema after endovascular embolization of unruptured intracranial arterial aneurysms. Radiol Oncol. 2015; 49 (4): 341-346. doi: 10.1515/raon-2015-0044.