Neurological Deterioration after Decompressive Suboccipital Craniectomy in a Patient with a Brainstem-compressing Thrombosed Giant Aneurysm of the Vertebral Artery.
10.7461/jcen.2016.18.2.115
- Author:
Woosung LEE
1
;
Yeon Soo CHOO
;
Yong Bae KIM
;
Joonho CHUNG
Author Information
1. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. ns.joonho.chung@gmail.com
- Publication Type:Case Report
- Keywords:
Decompressive craniectomy;
Giant intracranial aneurysm;
Neurologic deficits;
Thrombosis
- MeSH:
Aneurysm*;
Brain Stem;
Decompression;
Decompressive Craniectomy;
Humans;
Intracranial Aneurysm;
Laminectomy;
Male;
Middle Aged;
Neurologic Manifestations;
Quadriplegia;
Thrombosis;
Vertebral Artery*
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2016;18(2):115-119
- CountryRepublic of Korea
- Language:English
-
Abstract:
We experienced a case of neurological deterioration after decompressive suboccipital craniectomy (DSC) in a patient with a brainstem-compressing thrombosed giant aneurysm of the vertebral artery (VA). A 60-year-old male harboring a thrombosed giant aneurysm (about 4 cm) of the right vertebral artery presented with quadriparesis. We treated the aneurysm by endovascular coil trapping of the right VA and expected the aneurysm to shrink slowly. After 7 days, however, he suffered aggravated symptoms as his aneurysm increased in size due to internal thrombosis. The medulla compression was aggravated, and so we performed DSC with C1 laminectomy. After the third post-operative day, unfortunately, his neurologic symptoms were more aggravated than in the pre-DSC state. Despite of conservative treatment, neurological symptoms did not improve, and microsurgical aneurysmectomy was performed for the medulla decompression. Unfortunately, the post-operative recovery was not as good as anticipated. DSC should not be used to release the brainstem when treating a brainstem-compressing thrombosed giant aneurysm of the VA.
