6. Traumatic Intracranial Aneurysms; The Role and Importance of Early Cerebral Angiography

1.Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel

To present our experience with early diagnostic angiography and endovascular treatment of traumatic intracranial aneurysms (TICA).

From 2002–2021, diagnostic angiography was performed on patients with moderate-to-severe traumatic brain injury (TBI) involving a cranial base fracture or penetrating brain injury, with a tract from the penetrating agent entering at the pterional area, going through the middle cerebral artery (MCA) candelabra, and crossing the midline. TICAs were treated by various endovascular techniques.

81 patients with TBI underwent angiography (45 penetrating brain injuries, 36 blunt injuries); 28 TICAs were diagnosed (35% detection rate in the selected patients): 13 (46%) TICAs due to penetrating brain injuries and 15 (54%) due to blunt injuries. Glasgow Coma Scale (GCS) score at diagnosis ranged from 3–15. 8 aneurysms were located on branches of the MCA, 6 on pericallosal branches of the anterior cerebral artery (ACA), 1 on branches of the posterior cerebral artery (PCA), and 13 on the internal carotid artery (ICA). No post-procedure recanalization was detected in 26 patients. 2 patients needed retreatment. 1 patient with a right ICA (RICA) aneurysm (posterior communicating artery [PcomA] segment) was treated with endovascular coiling and 6 months later underwent re-embolization of the aneurysm using a flow-diverter stent due to asymptomatic subtotal occlusion. The other was treated with a bare stent and coiling but had a growing intracavernous pseudoaneurysm treated by ICA occlusion with extracranial-intracranial microvascular bypass. There were no procedure-related complications or mortality.

Early cerebral angiography provided an effective approach for TICA detection and management. Endovascular therapy is versatile and offers a valuable alternative to surgery, allowing early aneurysm exclusion with excellent results.