Giant serpentine aneurysms are rare huge and partially thrombosed aneurysms, with an eccentric tortuous intra-aneurysmal vascular channel. Surgical treatment is often necessary due to the great mass effect. We describe a case of a left-handed woman with a giant serpentine aneurysm of the left middle cerebral artery whose management was complex. The challenge was to exclude the aneurysm from circulation, reduce the mass effect, and, mostly, preserve the language function. Since the patient was left-handed the language dominance needed to be assessed; functional MRI (fMRI) and Wada test (WT) showed a right dominance. Surgical treatment was performed, as a complication, the patient developed left fronto-basal ischemia with a slight paresis of the right hand but without any language deficit. Our case shows the importance of a multidisciplinary team in patient management, with a pivotal role of neuroradiological functional tests in presurgical planning.

Giant serpentine aneurysm: Neuroradiological and neurosurgical management in a left-handed patient / Romano, Andrea; Moltoni, Giulia; Piazza, Amedeo; Trasimeni, Guido; Miscusi, Massimo; Palizzi, Serena; Romano, Allegra; Raco, Antonino; Bozzao, Alessandro. - In: RADIOLOGY CASE REPORTS. - ISSN 1930-0433. - 18:12(2023), pp. 4384-4388. [10.1016/j.radcr.2023.09.014]

Giant serpentine aneurysm: Neuroradiological and neurosurgical management in a left-handed patient

Andrea Romano;Giulia Moltoni
;
Amedeo Piazza;Guido Trasimeni;Massimo Miscusi;Serena Palizzi;Allegra Romano;Antonino Raco;Alessandro Bozzao
2023

Abstract

Giant serpentine aneurysms are rare huge and partially thrombosed aneurysms, with an eccentric tortuous intra-aneurysmal vascular channel. Surgical treatment is often necessary due to the great mass effect. We describe a case of a left-handed woman with a giant serpentine aneurysm of the left middle cerebral artery whose management was complex. The challenge was to exclude the aneurysm from circulation, reduce the mass effect, and, mostly, preserve the language function. Since the patient was left-handed the language dominance needed to be assessed; functional MRI (fMRI) and Wada test (WT) showed a right dominance. Surgical treatment was performed, as a complication, the patient developed left fronto-basal ischemia with a slight paresis of the right hand but without any language deficit. Our case shows the importance of a multidisciplinary team in patient management, with a pivotal role of neuroradiological functional tests in presurgical planning.
2023
functional MRI; language dominance; serpentine aneurysm; Wada test.
01 Pubblicazione su rivista::01i Case report
Giant serpentine aneurysm: Neuroradiological and neurosurgical management in a left-handed patient / Romano, Andrea; Moltoni, Giulia; Piazza, Amedeo; Trasimeni, Guido; Miscusi, Massimo; Palizzi, Serena; Romano, Allegra; Raco, Antonino; Bozzao, Alessandro. - In: RADIOLOGY CASE REPORTS. - ISSN 1930-0433. - 18:12(2023), pp. 4384-4388. [10.1016/j.radcr.2023.09.014]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1697022
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