title: Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.
abstract: Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Reig
authors.forename: Scott
authors.initials: S
authors.lastname: Simon
authors.forename: Robert A
authors.initials: RA
authors.lastname: Mericle
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications*; D002340:Carotid Artery Diseases / Q000628:therapy*; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D002648:Child; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic; D005260:Female; D006732:Horner Syndrome / Q000150:complications; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D015541:Off-Road Motor Vehicles; D011145:Polyvinyls / Q000627:therapeutic use*; D019291:Skull Base / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide