Partially thrombosed
intracranial aneurysm was difficult to treat because of higher recurrence rate compared to non-thrombosed
saccular aneurysm. The author reports a case of partially thrombosed
intracranial aneurysm causing transient ischemic symptom. A 40-year-old man presented with transient right
hemiparesis. Brain magnetic resonance imaging (MRI) depicted low-signal intensity target-like mass lesion on left sylvian fissure, and magnetic resonance angiography (MRA) showed
aneurysm on left middle cerebral artery bifurcation (MCBF), suggested thrombosed
aneurysm. On operative finding,
aneurysm wall had thick and atherosclerotic change, and it was
fusiform aneurysm not saccular type. We initially planned direct
clip for the
aneurysm, but it was failed due to collapse of parent artery after clipping on
aneurysm neck. To prevent
ischemia, extracranial-intracranial bypass was performed and then
thrombectomy with
clip reconstruction. To remodeling the
fusiform aneurysm,
stent-assisted coiling was performed for remnant portion of
aneurysm. With staged hybrid technique, giant thrombosed
fusiform aneurysm was completely obliterated and the patient did not suffer any
neurologic symptoms no longer.