Many treatments for posttraumatic, skull base
aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side
Horner syndrome caused by a 33 x 19-mm internal carotid artery
aneurysm at the C-1 level. We chose to treat the
aneurysm with a new liquid embolic agent for wide-necked, side-wall
aneurysms (
Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered
stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with
stent-assisted coil embolization. After the patient was treated with loading doses of
aspirin,
clopidogrel bisulfate, and
heparin, 99% of the
aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable
aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized
intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base
aneurysms in pediatric patients.