Journal of Cerebrovascular and Endovascular Neurosurgery  2015;17(2):113-119

doi:10.7461/jcen.2015.17.2.113

Seven Intracranial Aneurysms in One Patient: Treatment and Review of Literature.

Osama AHMED 1 ; Piyush KALAKOTI ; Matthew HEFNER ; Hugo CUELLAR ; Bharat GUTHIKONDA

Affiliations

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Keywords

Aneurysm; Coiling; Clipping; Subarachnoid hemorrhage; Intracranial

Country

Republic of Korea

Language

English

Abstract

Before the advent of endovascular coiling, patients with multiple intracranial aneurysms were treated with surgical clipping; however, with the advancements in endovascular technology, intracranial aneurysms can be treated with surgical clipping and/or endovascular coiling. We describe a case of subarachnoid hemorrhage in a patient with 7 intracranial aneurysms. A 45-year-old female developed a sudden headache and left sided hemiparesis. Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure. Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery). The patient underwent two craniotomies for surgical clipping of the anterior circulation aneurysms and endovascular stent-assisted coils for the posterior circulation aneurysms. The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy. We describe a case report and decision making for a patient with multiple intracranial aneurysms treated with surgical clipping and endovascular coiling.