A.  Carriero

D.  Surico

G.  Garofalo

N.  Surico

N. P.  Nuzzi

R.  Amadori

English

SURICO, Daniela

CARRIERO, Alessandro

SURICO, Nicola

R. Amadori

G. Garofalo

N. P. Nuzzi

Archivio Istituzionale della Ricerca- Università del Piemonte Orientale

BRIEF COMMUNICATIONS"One-shot" endovascular management of cerebral aneurysm and fourthventricle hemangioblastoma in a pregnant womanDaniela Surico a, Roberta Amadori a,⁎, Greta Garofalo a, Nunzio P. Nuzzi b, Alessandro Carriero b, Nicola Surico aa Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italyb Radiodiagnostic and Interventional Radiology Institute, University of Eastern Piedmont, Novara, Italya r t i c l e i n f oArticle history:Received 16 July 2014Received in revised form 25 September 2014Accepted 11 November 2014Keywords:Cerebral aneurysmEndovascular managementHemangioblastomaPregnancySubarachnoid hemorrhageAneurysmal subarachnoid hemorrhage (aSAH) during pregnancy isa serious condition [1]. The bestmanagement of aSAHduring pregnancyis not yet established, although endovascular coiling has gained favorover the last few years [2]. The incidence of hemangioblastoma of theposterior fossa in pregnancy is extremely low [3].Apregnantwomanpresented to the “Maggiore della Carita”Hospital inDecember 2009 having experienced sudden onset seizures and deteriora-tion of consciousness at 27 weeks of pregnancy. The patient’s systemicblood pressurewas 100/50mmHg and eclampsiawas therefore excluded.CT and MRI scans showed subarachnoid hemorrhage, blood in thelateral ventricles, and ventricular dilation (Fig. 1). The fourth ventriclewas occupied by a small mass—with hyperintense nodule enhancementon T2weighted imaging after gadolinium injection—rounded by a smallcyst with ring enhancement.MR angiography revealed a subarachnoid aneurysm arising from theright internal carotid artery. The patient underwent digital subtractionangiography that confirmed the presence of a subarachnoid aneurysmof the right internal carotid artery and a hypervascularized nodulewith arteriovenous shunt in the posterior fossa, fed by the posterior andanterior inferior cerebellar artery—consistent with hemangioblastoma.Following consultation with neurosurgeons, anesthesiologists,obstetricians, and neuroradiologists, the decision to immediately treatboth lesions by an endovascular approachwas taken. Before themedicalprocedure, the patient was advised about the potential risks andbenefits of the intervention and she provided informed consent.To begin, the posterior inferior cerebellar artery to the hemangio-blastoma was navigatted with a flow-directed microcatheter to reach thehypervascularized nodule. Then, 0.7 mL of a mixture of glue diluted to20% in Lipiodol (Guerbet, Bloomington, IN, USA) was injected into thenidus, followed by complete angiographic devascularization of the lesion(Figs. 2, 3). Immediately after, the aneurysm was coiled with threeplatinum bare coils. The procedure was uneventful.CT scan performed 24 hours after the procedure showed ventricularshrinking to a normal size (Fig. 4). The patient had good clinical status,with a Glasgow Coma Scale score of 14. At 38 weeks of pregnancy thepatient was admitted for a scheduled cesarean delivery, resulting inthe successful birth of a healthy neonate weighing 3220 g and with anInternational Journal of Gynecology and Obstetrics 129 (2015) 79–88⁎ Corresponding author at: Department of Obstetrics and Gynecology, “Maggiore dellaCarita”Hospital, VialeMazzini 18, 28100Novara, Italy. Tel.:+39 0321 3733665; fax:+390321 3733659.E-mail address: ierama@tin.it (R. Amadori).Fig. 1. CT scan showed subarachnoid hemorrhage, blood in the lateral ventricles, andventricular dilation.Contents lists available at ScienceDirectInternational Journal of Gynecology and Obstetricsj ourna l homepage: www.e lsev ie r .com/ locate / i jgoApgar score of 9/9. Follow-upMRI of the patient twomonths after deliv-ery showed no major recanalization of the aneurysm. As expected, theintraventricular mass was still present. Contrast-enhanced MR angiog-raphy showed revascularization of the lesion very close to the initialdigital subtraction angiography picture, but no ventricular dilationwas seen.The association of these pathologies in a pregnant woman isexceptional. The endovascular treatment approach used in this casewas successful and uneventful.Conflict of interestThe authors have no conflicts of interest.References[1] Meyers PM, Halbach VV, Malek AM, Phatouros CC, Dowd CF, Lawton MT, et al.Endovascular treatment of cerebral artery aneurysms during pregnancy: report ofthree cases. AJNR Am J Neuroradiol 2000;21(7):1306–11.[2] Tarnaris A, Haliasos N, Watkins LD. Endovascular treatment of ruptured intracranialaneurysms during pregnancy: is this the best way forward? Case report and reviewof the literature. Clin Neurol Neurosurg 2012;114(6):703–6.[3] Erdogan B, Sen O, Aydin MV, Bagis T, Bavbek M. Cerebellar hemangioblastoma inpregnancy. A case report. J Reprod Med 2002;47(10):864–6.Fig. 3. Complete angiographic devascularization of the hemangioblastoma (white arrow).Fig. 4. CT scan performed 24 hours after the procedure showed ventricular shrinking to anormal size (white arrows).Fig. 2. Angiographic shape of the hemangioblastoma before devascularization (whitearrow).http://dx.doi.org/10.1016/j.ijgo.2014.09.0230020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.80 Brief Communications

"One-shot" endovascular management of cerebral aneurysm and fourth ventricle hemangioblastoma in a pregnant woman.

Daniela Surico

Roberta Amadori

Greta Garofalo

Nunzio P. Nuzzi

Alessandro Carriero

Nicola Surico

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International Journal of Gynecology & Obstetrics

“One-shot” endovascular management of cerebral aneurysm and fourth ventricle hemangioblastoma in a pregnant woman

https://iris.uniupo.it/retrieve/handle/11579/56590/25276/one%20shot.pdf

"One-shot" endovascular management of cerebral aneurysm and fourth ventricle hemangioblastoma in a pregnant woman.

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