Development of a pontine cyst after endovascular coil occlusion of a basilar artery trunk aneurysm: Case report

Jonathan A. Friedman, Jon I. McIver, Frederic P. Collignon, Douglas A. Nichols, David G. Piepgras, Jay U. Howington, L. Nelson Hopkins, Bernd Richling, G. Michael Lemole, Andreas Gruber, Randall T. Higashida, Pierre Lasjaunias

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

OBJECTIVE AND IMPORTANCE: Cyst formation within the brain parenchyma after endovascular coil occlusion of an intracranial aneurysm is a previously undescribed occurrence. We describe a 70-year-old woman who presented with a symptomatic pontine cyst 1 year after uncomplicated stenting and Guglielmi detachable coil occlusion of an unruptured basilar artery trunk aneurysm. CLINICAL PRESENTATION: A 70-year-old woman presented with an episode of transient dysequilibrium and gait difficulty. Magnetic resonance imaging and cerebral angiography demonstrated a 15-mm distal basilar artery trunk aneurysm. Endovascular stenting and coil occlusion of the aneurysm were performed without technical complications. One year after the initial treatment, the patient developed progressive dysarthria, dysphagia, diplopia, and left hemiparesis. A large pontomesencephalic cyst adjacent to the coiled basilar aneurysm was identified on magnetic resonance imaging scans. INTERVENTION: A subtemporal craniotomy and decompression of the pontomesencephalic cyst were performed. The patient's symptoms of brainstem dysfunction improved temporarily but recurred within 2 months, necessitating reoperation for cyst drainage and placement of a cyst-peritoneal shunt. CONCLUSION: Intra-axial cyst formation after stenting and endovascular occlusion of an intracranial aneurysm is an unusual occurrence and should be considered in the differential diagnosis of new neurological deficits after endovascular treatment. The pathophysiological mechanism of cyst formation in this case is not known.

Original languageEnglish (US)
Pages (from-to)694-699
Number of pages6
JournalNeurosurgery
Volume52
Issue number3
DOIs
StatePublished - Mar 1 2003

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Keywords

  • Aneurysm
  • Basilar artery
  • Brainstem cyst
  • Coil occlusion
  • Endovascular therapy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Friedman, J. A., McIver, J. I., Collignon, F. P., Nichols, D. A., Piepgras, D. G., Howington, J. U., Hopkins, L. N., Richling, B., Lemole, G. M., Gruber, A., Higashida, R. T., & Lasjaunias, P. (2003). Development of a pontine cyst after endovascular coil occlusion of a basilar artery trunk aneurysm: Case report. Neurosurgery, 52(3), 694-699. https://doi.org/10.1227/01.NEU.0000048480.41325.17