CASE REPORT
Antecedentes: los aneurismas intracraneales (IA) son dilataciones anormales de los vasos sanguíneos que pueden romperse y causar condiciones potencialmente mortales. La formación de un aneurisma y su riesgo de ruptura están relacionados con eventos multifactoriales como la genética, la hemodinámica del flujo, la inflamación y la disfunción endotelial. Los aneurismas múltiples están presentes en un tercio de la población de aneurismas, pero sus factores de riesgo asociados y su tratamiento siguen siendo motivo de debate. Este caso detalla el primer paciente con 8 aneurismas sin causa identificable. Describimos la posible etiología, fisiopatología, plan de tratamiento propuesto, incluyendo el número de sesiones, la técnica de tratamiento y los pasos de manejo, así como algunos factores de riesgo de ruptura descritos en la literatura que consideramos para llevar a cabo un tratamiento ordenado. Caso Clínico: presentamos una mujer de 63 años con hipertensión como única historia clínica, que presentaba cefalea y fotofobia. En la resonancia magnética, se observaron múltiples aneurismas intracraneales (MIA). La angiografía reveló 8 aneurismas intracraneales de diferentes tamaños en ambas circulaciones carotídeas y un segmento A1 hipoplásico. Se descartaron posibles trastornos genéticos. Propusimos un manejo en dos sesiones con técnicas de embolización y puente endovascular para los aneurismas con mayor riesgo de ruptura, y una espera vigilante para los aneurismas de bajo riesgo. Conclusión: este reporte de caso presenta un hallazgo inusual de 8 aneurismas intracraneales no rotos sin causa identificable. La presencia de múltiples aneurismas intracraneales es relativamente común en la población de aneurismas, con la hemodinámica del flujo y las variaciones anatómicas vasculares jugando un posible papel en su formación. El manejo de múltiples aneurismas intracraneales sigue siendo un tema controvertido, pero el tratamiento endovascular con técnica de embolización es una modalidad efectiva para casos con alto riesgo de ruptura y técnicamente difíciles para la clipaje quirúrgico. Sin embargo, se deben diseñar planes de tratamiento individualizados para cada paciente basados en el riesgo de ruptura, la edad, la comorbilidad, el número de aneurismas y la ubicación.
Background: intracranial aneurysms (IA) are abnormal dilations of blood vessels that can rupture and cause life-threatening conditions. The formation of an aneurysm and its risk of rupture are related to multifactorial events such as genetics, flow hemodynamics, inflammation, and endothelial disfunction. Multiple aneurysms are present in a third of aneurysms population but their associated risk factors and treatment are still a matter of debate. The present case details the first patient with 8 aneurysms without an identifiable cause. We describe the possible etiology, pathophysiology, proposed treatment plan, including the number of sessions, the treatment technique and the management steps, as well as some rupture risk factors described in the literature that we considered in order to carry out an orderly treatment. Case Report: we present a 63-year-old female with hypertension as the only clinical history, who presented with headache and photophobia. On MRI, multiple intracranial aneurysms (MIA) were observed. The angiography revealed 8 intracranial aneurysms of different sizes in both carotid circulations and a hypoplastic A1 segment. Possible genetic disorders were ruled out. We proposed a two-session management with coiling techniques and woven endobridge for the aneurysms with higher risk of rupture, and watchful waiting for the low-risk aneurysms. Conclusion: this case report presents an unusual finding of 8 unruptured intracranial aneurysms without an identifiable cause. The presence of multiple intracranial aneurysms is relatively common in the aneurysm population, with flow hemodynamics and anatomical vascular variations playing a possible role in their formation. Management of multiple intracranial aneurysms is still a controversial issue, but endovascular treatment with coiling technique is an effective modality for high rupture risk and technically difficult cases for surgical clipping. However, individualized treatment plans should be designed for each patient based on the risk of rupture, age, comorbidity, number of aneurysms, and location.
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1Neurointerventional Surgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
2Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
3Hospital Militar Regional Irapuato, Irapuato, Guanajuato, Mexico.
4Neurointerventional Surgery Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
Received Apr 18, 2024
Accepted June 11, 2024
