Treatment and Postinterventional Management of a Fusiform Intracranial Aneurysm in a Professional Soccer Player: A Case Report

Figures

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  Figure 1. Initial imaging findings: (A) Initial computed tomography (CT) images reveal a hyperdense structure confined to the right Sylvian fissure, leading to further investigation with magnetic resonance imaging (MRI). (B) T2-weighted MRI images do not confirm the suspected hemorrhage; instead, a fusiform aneurysm located in the distal M2-segment of the right middle cerebral artery (MCA) is delineated. (C) Cerebral angiogram illustrates a fusiform aneurysm, located in the inferior trunk of the right MCA. Furthermore, fusiform dilatation of a parieto-occipital branch arising from the right MCA is seen. The lesions are located adjacent to the right insula, in the depth of the Sylvian fissure. (D) Three-dimensional volume-rendering technique (VRT) of the aneurysm.

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  Figure 2. Intra-interventional cerebral angiograms: (A) Lateral working projection during navigation of the microcatheter and microwire toward the aneurysm. (B) Directly after implantation of the flow diverter, contrast media stasis can be seen at the dome of the aneurysm as a gray, subtracted cap in the arterial phase. (C) In the venous phase, additional stasis in the majority of the aneurysm sack is depicted as a black band. (D) Postinterventional three-dimensional VRT showing the positioning of the flow diverter in relation to the aneurysm and marked stasis of contrast medium at the dome of the aneurysm.

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  Figure 3. Postinterventional imaging findings: (A) T1-weighted image 6 months after flow diverter implantation showing hyperintense thrombotic material around the flow diverter and near-complete occlusion of the aneurysm. The initial severe stasis at the dome (Figure 2B) is depicted as a hypointense cap. (B) Slow flow in the side branch originating from the aneurysm wall is documented 6 months post intervention after changing to monotherapy with aspirin. (C) Perfusion deficit of the affected territory is visible on mean transit time reconstructions of the MRI perfusion. (D) Small ischemic lesions, located in the right superior parietal lobule, are seen on DWI. (E) One month after detection of the slow flow in the side branch of the aneurysm-wall, T2-weighted images did not reveal an infarction in areas with delayed perfusion. (F) As 12 month-follow-up MRIs reveal, the aneurysm is completely filled with a hyperintense thrombotic material, which means that full occlusion of the aneurysm was achieved.