Successful Staged Obliteration of Three Unruptured Cerebral Aneurysms by Clipping, Coiling, and Proximal Occlusion: Report of a Case

Abstract

Endovascular techniques offer a mode of therapy alternative or adjuvant to surgery in treatment of multiple or inoperable cerebral aneurysms. Proximal arterial occlusion, with or without extracranial-to-intracranial (EC-IC) bypass, is frequently performed for inoperable cerebral aneurysms. The authors report hereby a 70-yearold woman presenting with the left cavernous sinus syndrome because of a giant inoperable internal carotid aneurysm. In addition, two other aneurysms were identified. The patient underwent staged obliteration of the three aneurysms by clipping, Guglielmi detachable coils (GDCs) embolization, and proximal internal carotid artery occlusion with golden valve balloons (GVBs). At 5-month follow-up, the cerebral angiogram showed that the left ICA aneurysm was completely obliterated, the right ICA aneurysm was totally occluded by GDCs, and the left MCA aneurysm was successfully clipped. In addition, the collateral circulation of the left hemisphere had been well reestablished. Symptoms and signs of the left cavernous sinus syndrome subsided about three months after the treatment. Triple aneurysms can be managed successfully with a combination of different therapies.