Basilar Fenestration Aneurysms Research Articles

Two Basilar Fenestration Aneurysms Management - Image in Neurosurgery

Two Basilar Fenestration Aneurysms Management - Image in Neurosurgery

P.129 Endovascular coiling of ruptured basilar fenestration aneurysm: case report and review of literature

Background: Basilar fenestration is a rare congenital anomaly. When present, it is commonly found at the proximal portion of the artery near the vertebrobasilar junction. Methods: This is a case report of a ruptured basilar fenestration aneurysm in a 47-year-male successfully treated with endovascular coiling. Results: A 47-year-old male presented with sudden onset headache, neck pain, blurry vision, nausea, vomiting, and diaphoresis. Cerebral angiogram revealed a saccular basilar fenestration aneurysm located at the vertebrobasilar junction measuring 3.1 x 2.6 x 3.4 mm with a 2.3 mm neck. Multiple coils were placed including Target 360 Nano 2mm x 4 cm (Stryker, Kalamazoo, MI, US), Target 360 Nano 1.5 mm x 2 cm (Stryker, Kalamazoo, MI, US), and Target Helical Nano 1.5 mm x 1 cm (Stryker, Kalamazoo, MI, US). A repeat angiogram revealed complete exclusion of the aneurysm with preservation of both vertebral arteries. Conclusions: A literature review was conducted on basilar fenestration aneurysms which included 158 patients from 39 studies. Overall, complete exclusion of the aneurysm was achieved in 75.8% of cases, with 22.4% of cases having residual flow and 1.8% of cases with unreported exclusion status.

Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review

Background/aim The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data.Materials and methods A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure. ResultsAneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively.ConclusionAlthough the number of cases is low in our study, to our knowledge, it is the widest series in the literature until today. Our results demonstrate that BAF aneurysms can be treated successfully and safely with different endovascular techniques, with more stent use in recent years.

Flanking the fenestration: circumferential limb-to-limb stent-assisted coiling of a basilar artery fenestration aneurysm

A man aged 61 years with a history of a ruptured basilar fenestration aneurysm underwent unassisted coiling in 1997 and repeat intervention for a recurrence at the aneurysm mouth in...

Flanking the fenestration: circumferential limb-to-limb stent-assisted coiling of a basilar artery fenestration aneurysm

A man aged 61 years with a history of a ruptured basilar fenestration aneurysm underwent unassisted coiling in 1997 and repeat intervention for a recurrence at the aneurysm mouth in...

Fenestra Obscura: Flow Diverter Reconstruction of a Complex Vertebrobasilar Aneurysm Through an Obscured Fenestration Limb: Technical Case Report.

Basilar fenestration aneurysms are rare, challenging intracranial vascular lesions with atypical anatomy. The posterior circulation represents a difficult therapeutic dilemma because of the close proximity of crucial life-sustaining brainstem structures. The use of flow diverter technology has been very limited in posterior circulation vessels. We present the case of a 49-year-old female patient, who was diagnosed with a symptomatic large vertebrobasilar junction aneurysm, which was initially thought to be a proximal basilar dilatation. The aneurysm was later verified to arise from the proximal end of a basilar fenestration, distended by the aneurysm fundus. The small-caliber fenestration limbs were the only connection to the distal basilar artery, but were stretched laterally and concealed by the aneurysm fundus. This complex lesion was successfully treated by flow diverter deployment through one of the fenestration limbs, followed by coiling of the aneurysm fundus, and sacrificing the contralateral vertebral artery. A 6-month follow-up angiogram showed remodeling of the basilar artery and complete occlusion of the aneurysm with good clinical outcome. Careful diagnostic workup, multidisciplinary discussions, and the innovative use of versatile endovascular technology were crucial to achieve an optimal result in this case. This is the first report of a successful basilar artery reconstruction for the treatment of a large atypical vertebrobasilar junction fenestration aneurysm by deployment of a flow diverter device directly in a small, obscured fenestration limb.

Double Microcatheter-Assisted Coiling of a Basilar Artery Fenestration Aneurysm

Sir, The incidence of basilar artery fenestration is approximately 0.6% in angiographic studies and more in autopsy studies [1]. The most common site of basilar artery fenestration is proximal part [2]. Basilar artery fenestration aneurysms are very rare, posing unique challenges. Reported incidence of aneurysm at basilar artery fenestration site is 7% [3]. Surgical treatment of such aneurysm is usually deferred because of risk of lower cranial nerves injuries, difficulty in exploring surgical field and unpaired arterial supply of brain stem. Endovascular treatment is preferable modality though challenging. We report a case of successful treatment of a wide-necked small (2.5×3 mm) basilar artery fenestration aneurysm with a novel microcatheter -assisted coiling technique using bifemoral approach. A 60-year-old woman presented with headache and vomiting for 3 days. Evaluation revealed diffuse subarachnoid hemorrhage on plain CT scan. Cerebral DSA revealed a ruptured (2.5×3 mm) broad-neck proximal basilar artery fenestration aneurysm that incorporated both limbs of the basilar fenestration and both distal vertebral arteries (Fig. 1). An excel 10 microcatheter (Boston Scientific, Natick, MA, USA) was deployed into the right limb of the basilar fenestration from the right distal vertebral artery to support aneurysm neck. Similarly, another excel 10 microcatheter was placed in proximal basilar fenestration aneurysm through left distal vertebral artery. Following microcatheter support from right side, the aneurysm was treated with coil-embolization through another microcatheter in aneurysm sac from left side (Fig. 2). In basilar artery fenestration aneurysm, either stent assisted coiling or balloon assisted coiling is preferred endovascular technique particularly in wide necked aneurysm to prevent occlusion of fenestrated arm or migration of coiling. Preservation of the fenestrated arm is important as angiographically invisible perforators to brain stem may occlude. Fenestrated basilar artery aneurysm has been classified into type A and type B in the literature [4]. Our case is fitting into type B aneurysm. In this rare case, microcatheter support obviated need of stent which requires antiplatelet use which would have been problematic in view of this being acute subarachnoid hemorrhage. This approach has enabled coil embolization of the aneurysm as well as preservation of both basilar fenestration limbs and both distal vertebral arteries. Fig. 1 Pre-treatment, left vertebral artery angiogram. Fig. 2 Post-treatment, right vertebral artery angiogram.

Basilar Trunk Aneurysms with Associated Fenestration Treated by Using Guglielmi Detachable Coils: Two Cases Reports

Basilar trunk saccular aneurysms associated with fenestration are infrequent. Surgical treatment of a basilar trunk aneurysm is difficult because of its anatomic environment and complicated surgical exposure. We experienced two cases of basilar fenestration aneurysm, and the patients were treated using Guglielmi detachable coils. The usefulness of 3-dimensional digital subtraction angiography and efficacy of endovascular treatment for basilar trunk aneurysms with associated fenestration is discussed in this article, and the relevant literature is reviewed.

Basilar Artery Fenestration Aneurysms Treated with Guglielmi Detachable Coils

Four patients with basilar artery fenestration aneurysms at the vertebra basilar junction were admitted after subarachnoid haemorrhage. In two of them attempted surgery failed. Subsequently, all four were embolised with Guglielmi Detachable Coils (GDC), three of them in the acute phase. In one case the initial embolisation was incomplete, but follow-up angiography demonstrated spontaneous total occlusion. In another, partial reopening was treated with further embolisation. Three patients recovered completely after treatment. One patient still has deficits related to surgery of an accompanying aneurysm at the middle cerebral artery. He is clinically improving but still not back at work. In two cases the fenestration was combined with a hypoplastic upper vertebral artery on one side. A hypoplastic veretebral artery on one side may frequently be part of the developmental anomaly of basilar fenestration aneurysms. The anatomical configuration and location of these aneurysms is such that their true nature is sometimes difficult to disclose at cerebral angiography and is only realised during embolisation. Treatment with GDC coils seems superior to surgery in basilar artery fenestration aneurysms.