Korean J Radiol.  2016 Dec;17(6):931-939. 10.3348/kjr.2016.17.6.931.

Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

• Park KY
• Kim BM
• Kim DJ

• KMID: 2466290
• DOI: http://doi.org/10.3348/kjr.2016.17.6.931

Abstract

OBJECTIVE
Few studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery.
MATERIALS AND METHODS
A total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated.
RESULTS
Single-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2-120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0-2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery.
CONCLUSION
Preoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.

Keyword

Brain tumor; Aneurysm; Coexistence; Treatment strategy; Coiling; Coil embolization

MeSH Terms

Adult
Aged
Brain Neoplasms/*diagnosis/surgery
Carotid Arteries/surgery
Embolization, Therapeutic/*methods
Female
Humans
Intracranial Aneurysm/*therapy
Male
Middle Aged
Preoperative Care
Retrospective Studies
Stents
Treatment Outcome

Figure

• 

  Fig. 1 53-year-old woman presenting with pituitary adenoma and coexisting unruptured aneurysm. A. Coronal view of T2 weighted MRI shows 5.3-mm sized aneurysm (arrow) buried in PA. Arrowheads indicate right internal carotid artery. B. Oblique coronal view of flat panel angiographic CT shows small aneurysm (arrow) arising from right internal carotid artery, with dome buried in PA. C. Control angiogram after coiling shows complete aneurysm occlusion. D. 6-month follow-up MR angiogram shows complete occlusion state of aneurysm (white arrow). PA = pituitary adenoma

• 

  Fig. 2 55-year-old man presenting with high grade glioma and concurrent unruptured aneurysm. A. Axial view of T2 weighted MRI shows 7.7-mm sized aneurysm (arrow) at anterior communicating artery and brain tumor with cystic portion (T) in left frontotemporal region. Note dome of aneurysm is toward brain tumor. B. Working projection view of angiogram during coiling. C. Control angiogram after coiling shows complete occlusion of aneurysm. D. Axial view of T2 weighted MRI after tumor surgery. Arrow indicated coiled aneurysm.

• 

  Fig. 3 68-year-old woman presenting with left parietal convexity meningioma and coexisting unruptured aneurysm. A. Sagittal view of enhanced MR shows meningioma with peritumoral edema in left parietal convexity. B. Lateral projection of left internal carotid angiogram shows large aneurysm with daughter sac at left posterior communicating artery origin. C. Control angiogram after coiling shows complete aneurysm occlusion. D. MR-DWI obtained due to transient ischemic attack (grade 4 contralateral hemiparesis) shows several high signal spots. MR-DWI = magnetic resonance diffusion weighted imaging E. Axial view of T2 weighted MRI after tumor removal. Patient had grade 4 contralateral weakness after brain tumor surgery, but recovered over several weeks. F. 2-year follow-up MR angiogram shows complete occlusion state of aneurysm (white arrow). 2-year Functional status of this patient was mRS 1. mRS = modified Rankin Scale

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