Middle Cerebral Artery Aneurysm: Multiple Intracranial Aneurysms Treated in Two Endovascular Sessions – Different Treatment Techniques in One Patient

Abstract

We present the case of a patient who had a family history of intracranial aneurysms and presented with tinnitus in the left ear. She was found to have six aneurysms on multiple brain arteries. She was treated with multiple devices over two sessions with good clinical and radiological outcomes, confirmed at the 12-month follow-up. In this chapter we will discuss the approach taken in patients with multiple brain aneurysms in which combined endovascular techniques are needed. The treatment should focus on occluding all the aneurysms in order to prevent subarachnoid hemorrhage, if possible starting with the one with the highest rupture risk. The therapeutic concept involves treating more than one aneurysm per session with the advantage of lower hospital care costs and fewer anesthesia sessions. However, the use of high doses of contrast medium and prolonged anesthesia should also be taken into consideration. The number of aneurysms treated per session depends on the location of these, the distance between them, the size of the aneurysm necks, and indeed of the aneurysms themselves. Treatment strategy in patients with multiple intracranial aneurysms is the main topic of this chapter.