Tandem balloon test occlusion for a large unruptured aneurysm associated with persistent primitive trigeminal artery: technical note

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  • TANAKA Teppei
    Department of Neurosurgery, Fujita Health University School of Medicine
  • SADATO Akiyo
    Department of Neurosurgery, Fujita Health University School of Medicine
  • HAYAKAWA Motoharu
    Department of Neurosurgery, Fujita Health University School of Medicine
  • OOMURA Masahiro
    Department of Neurology, Nagoya City East Medical Center
  • MAEDA Shingo
    Department of Neurosurgery, Fujita Health University School of Medicine
  • ADACHI Kazuhide
    Department of Neurosurgery, Fujita Health University School of Medicine
  • WATABE Takeya
    Department of Neurosurgery, Fujita Health University School of Medicine
  • HIRAMATSU Hisaya
    Department of Neurosurgery, Hamamatsu Medical University School
  • IMIZU Shuei
    Department of Neurosurgery, Fujita Health University School of Medicine
  • NEGORO Makoto
    Department of Neurosurgery, Fujita Health University School of Medicine
  • HIROSE Yuichi
    Department of Neurosurgery, Fujita Health University School of Medicine

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Other Title
  • 遺残三叉神経動脈分岐部に生じた大径内頚動脈瘤に対する tandem balloonによるballoon test occlusion
  • イザンミツマタ シンケイ ドウミャク ブンキブ ニ ショウジタ タイケイ ナイ ケイ ドウミャクリュウ ニ タイスル tandem balloon ニ ヨル balloon test occlusion

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Objective: We report a case of unruptured large aneurysm associated with persistent primitive trigeminal artery (PTA) treated by endovascular trapping after balloon test occlusion (BTO) with tandem balloons.<br>Case presentation: A 37-year-old woman presented with diplopia and ptosis due to left oculomotor palsy. Cerebral angiography revealed a left PTA and unruptured large aneurysm at the junction of the PTA and the left internal carotid artery (ICA). The left carotid angiogram showed filling of the upper basilar artery via the PTA, and the left vertebral angiogram also showed filling of the basilar artery and entire posterior circulation. To evaluate the tolerance for the aneurysm trapping, we performed BTO with tandem balloons placed both proximal and distal to the aneurysm to isolate the left anterior circulation from both the ICA and PTA. As the mean stump pressure was below 60% of pre-BTO value, left superficial temporal artery-middle cerebral artery anastomosis was performed a week before endovascular trapping. Subsequently, the aneurysm, ICA, and PTA were successfully embolized with coils, leading to completion of trapping of the aneurysm, without causing any new neurological deficits.<br>Conclusion: To evaluate the precise hemodynamics and collateral circulation, BTO using tandem balloons seems to be useful in cases of persistent PTA.

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