A case report on dissecting giant middle cerebral artery aneurysm in a six years old patient: Combined approach

Abstract

Background and importanceThis article discusses a case of a partially thrombosed giant dissecting aneurysm of the middle cerebral artery (MCA) in a 5-year-old child. The current literature regarding giant dissecting MCA aneurysm treatment confirms the rarity of this pathology in children as well as the lack of treatment guidelines for it. A number of articles call for surgical intervention in case of a symptomatic dissecting MCA aneurysm. They suggest revascularization techniques with subsequent removal of the aneurysm from the circulation. However, there is no consensus on the time of intervention when treating symptomatic aneurysms. This case involved a microsurgery low-flow anastomosis followed by endovascular occlusion of the aneurysm-bearing middle cerebral artery with preservation of the aneurysm dome. Although this modality has proven effective for a giant dissecting MCA aneurysm in a child, more data on similar cases needs to be processed before quoting it as the most favorable approach. Clinical presentationA 5-year-old boy suffering from a severe headache, fatigue, vomiting and oppressed consciousness was diagnosed with a giant dissecting partially thrombosed aneurysm of middle cerebral artery. The treatment involved a combined microsurgical and endovascular approach with no serious neurologic deficit after the surgery. Over the next year, the follow-up of the patient revealed improvement in the child's condition, which meant a decrease in the size of the thrombosed part of the aneurysm and a radical occlusion of the aneurysm. ConclusionThe literature describes the most efficient procedure of pre-revascularization before the occlusion of dissecting MCA aneurysms. This article suggests a modality which involves leaving the dome of a giant aneurysm after a combined intervention. This, in turn, could prevent additional damage to the child's brain. In fact, this technique seems a viable treatment option for the pathology in view. Being less invasive as it is, it associates with less risk of complications.