We report on a case of a giant aneurysm of the internal carotid artery in a 11-year old boy presenting with gradual unilateral visual loss, combined with slight headache and retro-orbital pain. Endovascular balloon occlusion of the internal carotid artery combined with monitoring of somatosensory evoked potentials was performed. Follow-up MR imaging six months after balloon occlusion revealed complete thrombosis and considerable retraction of the aneurysm. However, visual loss persisted, since therapy was initiated too late and optic nerve atrophy had already occurred.
It is important to emphasize that visual disturbance should be considered as an emergency, and, although rare, aneurysms do occur in the pediatric population.
Key words
Cerebral aneurysm - Balloon occlusion - Carotid artery occlusion - Childhood - Endovascular - Somatosensory evoked potentials
References
-
1
Fox A J, Vinuela F, Pelz D M.
Use of detachable balloons for proximal artery occlusion in the treatment of inclippable cerebral aneurysms.
J Neurosurg.
1987;
66
40-46
-
2
Friedmann W A, Chadwick G M, Verhoeven F J, Mahla M, Day A L.
Monitoring of somatosensory evoked potentials during surgery of middle cerebral artery aneurysms.
Neurosurgery.
1991;
29
83-88
-
3
Larson J J, Tew J M, Tomsick T A, van Loveren H R.
Treatment of aneurysms of the internal carotid artery by intravascular balloon occlusion: Long term follow-up in 48 patients.
Neurosurgery.
1995;
36
23-30
-
4
Linskey M E, Sekhar L N, Mirsch W L, Jonas H, Horton J A.
Aneurysms of the intracavernous carotid artery: Natural history and indications for treatment.
Neurosurgery.
1990;
26
933-938
-
5
Locksley H B.
Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part 1. Natural history of subarachnoid hemorrhage, intracranial aneurysms, and arteriovenous malformations. Based on 6368 cases in the Cooperative Study.
J Neurosurg.
1966;
25
219-239
-
6
Mathis J M, Barr J D, Jungreis C A, Yonas H, Sekhar L N, Vincent D. et al .
Temporary balloon test occlusion of the internal carotid artery: Experience in 500 cases.
Am J Neuroradiol.
1995;
16
749-754
-
7
Patel A N, Richardson A E.
Ruptured intracranial aneurysms in the first decades of life. A study of 58 patients.
J Neurosurg.
1971;
35
571-576
-
8
Timpermann P E, Tomsick T A, Tew J M, van Loveren H R.
Aneurysm formation after carotid occlusion.
Am J Neuroradiol.
1995;
16
329-331
-
9
Vinuela F, Duckwiler G, Mawad M.
Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients.
J Neurosurg.
1997;
86
475-482
-
10
Voris M C.
Complications of ligation of the internal carotid artery.
J Neurosurg.
1980;
53
22-27
M. D. Arnd Dörfler
Department of Neuroradiology University of Essen Medical School
Hufelandstrasse 55
45122 Essen
Germany
Email: E-mail: arnd.doerfler@uni-essen.de
