Endovascular treatment and follow-up results of intracranial aneurysms with perianeurysmal edema

Purpose: We aimed to present the endovascular treatment and follow-up results of patients with intracranial aneurysms and vasogenic edema around the aneurysm in brain MRI examination. Materials and Method: Between January 2010 and March 2022, 29 patients who were treated at Necmettin Erbakan University Meram Medical Faculty, Department of Radiology, Interventional Radiology Unit were included in the study. The clinical status of the patients before the procedure was evaluated with the Modified Rankin Scale. After the treatment, they were called for control in the 1st month, 6th month, first year and later years. Controls were performed with MR Angiography and DSA to evaluate aneurysm filling, while edema was monitored with Uncontrast Brain MRI. Results: A total of 29 patients, 15 (51.7%) male, 14 (49.3%) female, aged between 31 and 83 (mean 58.4) were included in the study. Aneurysm sizes ranged from 5 mm to 80 mm (partial thrombosed) (median diameter 26.03 mm). Eleven of the included patients had partial thrombosed aneurysms. SAH was detected in 5 patients at the time of diagnosis. Locations of aneurysms; 10 MCA bifurcation(%35), 5 basilar artery(%16), 4 ICA(%14), 2 ophthalmic artery(%7), 1 choroidal artery(%3.5), 1 vertebral artery(%3.5), 1 ACA-A1 junction(%3.5), 1 ACom(%3.5), 1 SSA(%3.5), 1 PICA(%3.5), 1 PCA-P2 junction(%3.5), 1 MCA M2-M3 junction(%3.5) was determined as. In addition to aneurysm, intracranial AVM was detected in 2 patients. The mean follow-up period after the procedure was 21 months, and the interval was between 1-45 months. In the long-term follow-up of the patients, Type 1 (100% occlusion) was observed according to the Modified Raymond-Roy classification in 21 patients, while Type 2 (residual neck) occlusion was observed in 4 patients. While 1 refilling aneurysm was treated with WEB and 1 aneurysm current converter, 2 patients did not come for treatment. Edema findings decreased in 19 patients compared to yhe initial MRI, remained stable in 5 patients and increased due to infarction in 1 patient. In the long term follow up, 19 patients survived as asymptomatic, while 10 patients died. Conclusion: Although perianeurysmal edema is a rare complication of intracranial aneurysms, most of the time, patients may be asymptomatic or present with nonspecific headache, as in our study. As a result of our study, we think that large and giant aneurysms and partially thrombosed aneurysms are in the risky group in terms of edema, consistent with the literature. Endovascular treatment both eliminates the risk of ruptures and reduces perianeurysmal edema, as we have shown in our study. Key Words: Intracranial aneurysm, perianeurysmal edema, endovascular treatment, MR Imaging