Mariinskaya Hospital, Saint Petersburg, Russia
Development of surgical methods and technical devices for performing intravascular operations on intracranial aneurysms has led to appearance of the first scanty reports on successful embolization of aneurysms of the pericallous artery in medical literature. Information scantiness is determined by rarity of this pathology on the one hand and complexity of catheterizing aneurysms of distal segments of major arteries on the other.
In 1990-1994 Civit T. et al.  performed aneurysm embolization in 8 patients; aneurysm of the pericallous artery was diagnosed in 1 of them. They described their initial experience of aneurysm embolization, including that of the above localization. It allowed to come to the conclusion, that embolization was not as difficult as it was thought to be rather often.
Pierot L. et al.  confirmed possibility of performing intravascular operations on such aneurysms in 1996. According to their opinion, developed microsurgical instruments (microcatheters, microguides, microspirals) made it possible to catheterize and to exclude difficult-of-access “distal” aneurysms from blood circulation; it concerned aneurysms of the pericalous artery as well. At the same time, the authors emphasized considerable technical difficulties, usually conditioned by anatomic peculiarities and a small size of aneurysm.
The report by Menovsky T. et al.  is devoted to estimation of surgical anatomy, technical feasibility and clinical results of embolizing ruptured aneurysms of the pericallous artery with detachable spirals. They operated 12 patients (the II-IV stage according to Hunt-Hess Scale) during 27 months. There were 6 cases with intracranial hematomas. Total and subtotal exclusion of aneurysms from blood circulation was achieved in 11 and 1 patients respectively. Aneurysm revascularization, caused by spiral compression and progressing during 6 months, was observed in 1 case. Excellent (11) and satisfactory (1) results were watched during 9.2 months on the average. Thus, the authors concluded, that intravascular embolization of such aneurysms could be regarded as an alternative of clipping.
During 11.2003-11.2004 we performed 43 embolizations of cerebral aneurysms in an acute period of their rupture. Aneurysm of the pericallous artery was watched in 1 female patient. This case will be described below.
Female patient B., aged 48, was admitted to the hospital on the 8th day after verified subarachnoid hemorrhage. She was in a state of moderate severity (stage II according to Hunt-Hess Scale) and complained of headache. There were behavioral disorders and moderate meningeal syndrome; besides, the patient was uncritical and euphoric.
Spiral CT and CT angiography showed regressive intracerebral hematoma of the left frontal lobe (Fig.1) and saccular aneurysm (5 mm in diameter) of the left pericallous artery (Fig.2).
The operation was made on the 15th day. It consisted in aneurysm embolization with hydraulically detachable spirals, manufactured by Cordis (Johnson&Johnson Company).Catheterization of the left ICA was performed through the right femoral artery (Envoy 6 F). Subtraction carotid angiography confirmed presence of aneurysm of the left pericallous artery with a diameter of 5 mm (Fig.3). The Prawler+ microcatheter was introduced into the aneurysm cavity (Fig.4). The aneurysm was embolized with Trufill DCS Complex Fill 5´15. Control carotid angiography demonstrated contrasting of only precervical area of aneurysm (Fig.5).
There were minor speech disturbances and right-side hemiparesis (the score of up to 3) in a postoperative period. They regressed by the time of discharge. The patient’s state was satisfactory. Further treatment was carried out in a sanatorium.
Thus, use of modern microsurgical instruments allows to perform intravascular embolization of “distal” aneurysms of cerebral vessels. It is proved by the given example of exclusion of the pericallous artery aneurysm from blood circulation. Our experience of using instruments, manufactured by Cordis (Johnson&Johnson Company), has confirmed possibility of their application in such pathology. However, careful selection of instruments and correct choice of an operation algorithm in difficult-of-access aneurysms are important.