Abstract
Basilar tip aneurysms are the commonest aneurysms of the posterior circulation and constitute around 5-8% of all cerebral aneurysms. Ruptured basilar tip aneurysms may present with signs and symptoms of subarachnoid hemorrhage (SAH) with sudden, extremely severe headache, nausea and vomiting, stiff neck, blurred or double vision, sensitivity to light, seizure, drooping eyelid and loss of consciousness. At times, the hemorrhage could be fatal, reaching mortality beyond 20%. Basilar tip aneurysms have complex anatomy and have always been considered difficult to treat. Two well-known options to treat basilar tip aneurysms include the microsurgical approach and the endovascular approach. Endovascular treatment is now a cost-effective, preferred and logical rationale for the management of intracranial aneurysms. This case reports the first ever coiling procedure that was performed at Ziauddin Hospital (North Campus) for a basilar tip aneurysm and the other major challenge faced at our center was that the neck was wide, hence requiring a supporting balloon.
Highlights
Basilar tip aneurysms constitute around 5-8% of all intracranial aneurysms[1,2]
A 46-year-old male patient was brought to the emergency room (ER) of Ziauddin hospital (North campus) with a history of severe/splitting headache, vomiting, double vision and altered level of consciousness
The patient was stabilized in the ER and an urgent CT (Computerized tomography) scan of the brain was done which revealed diffuse subarachnoid hemorrhage (SAH) with severe brain edema (Figure 1a)
Summary
Basilar tip aneurysms constitute around 5-8% of all intracranial aneurysms[1,2]. Surgical clipping is a difficult and risky option with a high risk of increased morbidity[3,4]. Inayat Ali Khan, Irfan Lutfi, Muhammad Ali, Atiq Ahmed Khan with the family and the coiling option was accepted as the procedure of choice This was going to be the first ever coiling procedure for an aneurysm of the posterior circulation; the interventional radiologist (IR) was wary of the challenge with the additional fact that this patient needed a supporting device (balloon) for the wide neck without which the chances of successful coiling would not have been possible. Coiling of basilar tip aneurysms (BTAs) is a procedure, which is not new to the world of neurosurgery or the interventional radiologist in general This procedure (Figure 2a and 2b) was performed for the first time at Ziauddin hospital (North campus); it was a bit more challenging because this aneurysm in particular had a wide neck. The patient is being followed up regularly in the outpatient, fully ambulant, conscious, no symptoms of headache, excellent appetite
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