Clinical Advantage of 3D Imaging in Intracranial Aneurysm

Abstract

Intracranial aneurysms have a variety of causes including high blood pressure, atherosclerosis, trauma, heredity and abnormal blood flow and abnormal blood flow at the bifurcation level (where major artery splits to branches). There are other rare causes of aneurysms. As an example, mycotic aneurysms are caused by infection of the artery wall.

Pathophysiology/ progress of disease

• Artery wall at bifurcation level may become weak, causing a ballooning of the blood vessel wall to potentially form a small sac or aneurysm.

• Cerebral aneurysms are common, but most are asymptomatic and are found incidentally at autopsy.

• Aneurysms can leak or rupture causing symptoms from severe headache to stroke-like symptoms, or death.

Treatment strategies include traditional surgical repair of the aneurysm. This requires the neurosurgical team to perform major surgery that includes opening the head skull to put a clip across the weak blood vessel wall. On the other hand, some patients may be treated by an interventional radiologist or neurologist who may use a coil to fill the aneurysm to prevent bleeding.

Case presentation

A 52-year-old female patient brought into AMC (Arab Medical Centre - Amman) emergency department, complaining of vertigo, dizziness and family reported syncopal attack at home. She is a smoker but has no history of hypertension or diabetes.

On presentation, patient was stable, conscious and oriented with severe headaches. Blood pressure was 169/105. Initial clinical diagnosis was confirmed by brain CT, MRA and MRI which confirmed left middle cerebral artery (LMCA) aneurysm. There was evidence of sub-arachnoid hemorrhage with no midline shift.

The neurologist, neurosurgeon and interventional radiologist decided that the interventional option in the catheter laboratory was the best option and in the best interest of the patient with excellent results anticipated.

The patient was immediately transferred to the catheter laboratory for the endovascular procedure and the angiogram was done.

Discussion

Cerebral angiogram confirmed the site of aneurysm in LMCA; however, the use of 3D technology facilitated road mapping of the aneurysm during the treatment.

The use of 3D technology enables the physician and catheter laboratory team to facilitater road mapping. This contributes to increase safety for patients during treatment of cerebral artery aneurysm and increases the potential success rate. The dimensions of the vessel can be easily visualized.

The technology can be adapted with software and is relatively easy to be trained to use.

3D technology helps in controlling the image throughout the procedure.

Finally, contrast media used to assist the interventional radiologist to perform full procedure with the right images is significantly less. Total time procedure is less in expert centers to image the right vessel in the optimum projection. Clear imaging is always accompanied with increased safety and lesser complications.