Fusiform Basilar Artery Aneurysm Research Articles

Direct V3 Vertebral Artery Access for Embolization of Partially Thrombosed Fusiform Basilar Trunk Aneurysm: Technical Case Instruction.

Fusiform vertebrobasilar aneurysms carry significant morbidity. Endovascular strategies are preferred; however, unsafe or unfeasible access can call for innovative strategies. An octogenarian patient with an enlarging fusiform proximal basilar artery aneurysm causing a sixth nerve palsy was found to have multiple anatomic features that precluded a transradial or transfemoral endovascular approach. She was thus treated with direct microsurgical access of the V3 segment of the vertebral artery for subsequent coil embolization and flow diversion. This case introduces a novel combined microsurgical and endovascular strategy for treating a complex partially thrombosed fusiform basilar artery aneurysm. This approach should be reserved only for patients where conventional endovascular access is dangerous or unfeasible.

Super-giant fusiform basilar artery aneurysm.

Intracranial aneurysms are focal pathological dilatation of the arteries with a prevalence of 3.2%. Mainly genetic disorders, family history, hypertension and smoking put patients at high risk of intracranial aneurysms formation. MR angiogram, CT angiogram or conventional angiography can detect aneurysms 5 mm or larger in size. Fusiform aneurysms are rare and mainly due to dissection or atherosclerosis. Majority of these are in the posterior circulation and represent 3-13% of all intracranial aneurysms. These may be presented as stroke, cranial nerve palsies, brainstem compression and SAH. A diameter greater than 10 mm is a risk factor for rupture and warrants early intervention.

Abstract Number ‐ 137: Delayed aneurysmal rupture of a giant fusiform vertebrobasilar aneurysm after flow‐diversion embolization with adjunctive coiling

Introduction Vertebrobasilar aneurysms carry a high risk of operative morbidity and high mortality risk with rupture. Treatment with flow diversion embolization has gained popularity. While adjunctive coiling may lower the risk of delayed aneurysm rupture (DAR), DAR can occur during stent endothelialization. describe a case of DAR following flow diversion with adjunctive coil embolization of a giant vertebrobasilar aneurysm and review the literature to further characterize this phenomenon. Methods PubMed was queried using search terms: “delayed,” “aneurysm,” “rupture,” “flow diverter,” “flow diversion,” and “flow diverting stent” yielding 220 results. There were 47 studies describing 89 patients with DAR after flow diversion. Results A forty‐five‐year‐old male presented with posterior fossa compression symptoms secondary to a 30‐mm fusiform basilar artery aneurysm, which grew during short‐interval follow‐up to 35 mm. The patient consented to endovascular embolization. Tri‐axial catheter access system was used to deploy seven telescoping flow diverters from the basilar tip to the intradural left vertebral artery, and nine coils were subsequently deployed in the aneurysm dome. The right vertebral artery was coil embolized. The procedure was uncomplicated and the patient was continued on dual‐antiplatelet therapy. Four weeks later, the patient became unresponsive with absent brainstem reflexes, workup revealed diffuse subarachnoid hemorrhage with intraventricular hemorrhage. Digital subtraction angiography demonstrated contrast extravasation at the aneurysm neck. He succumbed to his neurological injury two days later. Out of 89 patients with DAR after flow diversion, only 3 occurred in fusiform basilar aneurysms treated with adjunctive coil embolization. Only one case, a 37.1‐mm aneurysm treated with 3 flow diverters with adjunctive embolization, occurred at greater than 30 days post‐intervention. Conclusions This case highlights the need to better characterize the role of adjunctive coiling with flow diversion for large or giant aneurysms, and to better understand risk factors related to delayed aneurysm rupture.

Ischemic stroke in a patient with giant fusiform aneurysm of dolichoectatic basilar artery and Covid-19 infection

Ischemic stroke in a patient with giant fusiform aneurysm of dolichoectatic basilar artery and Covid-19 infection

Internal Carotid Artery to Posterior Cerebral Artery Bypass for Fusiform Basilar Artery Aneurysm: 2-Dimensional Operative Video.

Fusiform dolichoectatic basilar trunk aneurysms pose an immense surgical challenge because of the extremely eloquent tissue at risk during the procedure and the complex management strategies required to relieve mass effect on the brainstem. The patient presented in this case experienced progressive brainstem deterioration with quadraparesis and multiple cranial neuropathies. The patient underwent a modified orbitozygomatic craniotomy for visualization, and an end-to-side anastomosis between a radial artery interposition graft and the posterior cerebral artery was performed, followed by an end-to-side anastomosis of the interposition graft to the intracranial internal carotid artery. A permanent clip was applied to the top of the basilar trunk to obliterate distal flow. Postoperative imaging demonstrated progressive thrombosis of the fusiform aneurysm. Basilar aneurysms represent challenging lesions for both microsurgical and endovascular treatments. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Posterior Fossa Craniectomy with Endovascular Therapy of Giant Fusiform Basilar Artery Aneurysms: A New Approach to Consider?

The prognosis of unruptured giant basilar artery (BA) aneurysms is very poor. No treatment has shown efficacy in survival. This pilot case-control study examines the overall survival (OS) benefit of combined surgical and endovascular management of giant BA aneurysms. Combined treatment including posterior fossa craniectomy followed by endovascular treatment was performed in 3 patients with giant BA aneurysms. OS of the 3 patients was compared with a control group of 6 patients (ratio 1:2) treated with the endovascular procedure only. The mean survival time was 32.6 months in the craniectomy group (SD 9.01, 95% confidence interval [14.9, 50.3]) and 3.5 months in the control group (SD= 2.08, 95% confidence interval [0.001, 7.6]; Mantel-Cox test P < 0.04). At mean follow-up of 36.5 months (SD 10.2), 2 of 3 patients had a favorable outcome with a Glasgow Outcome Scale score of 5. Univariate analysis determined that women had a statistically higher OS than men (33.7 months vs. 3.058 months for men; log-rank test P= 0.011). A similar outcome was obtained in the presence of a circulating posterior communicating artery (P= 0.03) and in the presence of an endovascular right vertebral artery occlusion (P= 0.022). Our study suggests that preventive posterior fossa craniectomy increases significantly OS of patients with giant BA aneurysms.

E-035 Symptomatic Fusiform Basilar Artery Aneurysm: "Kissing" Stent Reconstruction

IntroductionA case presentation of the treatment of a large-giant, symptomatic, fusiform basilar artery aneurysm using kissing telescopic stents. The patient is a 53 year old male who presented for further...

Glossopharyngeal Neuralgia Due to Vertebrobasilar Dolichoectasia Coexisting with Fusiform Aneurysm of the Basilar Artery

Glossopharyngeal neuralgia (GPN) refers to paroxysmal severe pain located to glossopharyngeal part or ear, which is a rare clinical event. In this report, we describe a patient suffered from glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia (VBD). A 72-year-old Chinese male was referred to our clinic with a complaint of paroxysmal severe pain in the right external auditory canal and auricle since 1 month, which could be precipitated by feed and accompanied with the vagus nerve irritation (bradycardia, low blood pressure, syncope) sometimes. Both computed tomographic angiography and digital subtraction angiography demonstrated a VBD (maximum diameter 5.7 mm) and a large fusiform aneurysm of basilar artery (maximum diameter 13.8 mm). The diagnosis is established on clinical and radiological signs. This is the first report of this kind in the literature. Although a few cases demonstrate that VBD can cause GPN, it should be considered as a possible etiology in patients with GPN.

Combined endovascular and surgical treatment of fusiform aneurysms of the basilar artery: technical note

To present the combined treatment of fusiform basilar artery aneurysms consisting of a surgical posterior fossa decompressive craniectomy and ventriculoperitoneal (VP) shunt operation at the same sitting, before the endovascular procedure with telescopic stenting of the aneurysmatic vessel segment in four cases. Combined treatment involving surgical procedure consisting of ventriculoperitoneal shunt placement for hydrocephalus and an occipital bone craniectomy and C1 vertebrae posterior laminectomy to decompress the posterior fossa in the same session. After surgery, the patients were loaded with acetylsalicylic acid and clopidogrel, and then the endovascular treatment was performed. All of the procedures were performed successfully without technical difficulty. The patients tolerated the procedures well and all cases showed remodelling with the overlapping stent technique. The patients were discharged home with baseline neurological situation and computed tomography (CT) angiography was performed at the 3rd month. This technique is a safer endovascular approach to treating symptomatic fusiform basilar artery aneurysms by protecting patients from both the haemorrhagic complications of anticoagulant therapy and thrombotic complications due to the interruption of anticoagulant therapy, while treating the hydrocephalus and compression by surgical means.

E-078 Enhanced flow diversion for ruptured fusiform basilar artery aneurysm: case report

IntroductionRupture of fusiform basilar aneurysm is typically fatal despite best efforts. We report good short-term outcome after endovascular basilar artery recontruction in a patient with fusiform basilar aneurysm who presented...

De Novo Large Fusiform Posterior Circulation Intracranial Aneurysm Presenting With Subarachnoid Hemorrhage 7 Years After Therapeutic Internal Carotid Artery Occlusion

Although the use of proximal artery occlusion, or hunterian ligation, for the treatment of intracranial aneurysms has decreased greatly over the past decades, this approach still finds use for certain giant and complex aneurysms. The main risks of artery sacrifice are ischemic complications but also, although rare, de novo aneurysm formation. We present here a case of de novo formation of a large fusiform basilar artery aneurysm 7 years after internal carotid artery occlusion. A 17-year-old male patient with a history of a giant right cavernous aneurysm treated 7 years earlier with right-sided endovascular internal carotid artery occlusion presented to our institution with a thunderclap headache. At the time of initial evaluation, the patient was neurologically intact and imaging revealed a 22 × 10-mm fusiform aneurysm of the distal basilar artery with mass effect on the adjacent pons as well as a small amount of subarachnoid and intraventricular blood. Complete occlusion of the right internal carotid artery was demonstrated with retrograde filling of the right middle cerebral artery from the enlarged right posterior communicating artery. The patient was subsequently treated with hunterian occlusion of the basilar artery below anterior inferior cerebellar arteries. A superficial temporal artery to middle cerebral artery bypass was performed on the right side before this occlusion. Further studies on the epidemiology of de novo aneurysms after carotid artery occlusion are warranted. Patients at higher risk of the development of intracranial aneurysms should be followed aggressively after hunterian ligation, and the possibility of an extracranial-intracranial bypass should be discussed.

“Double-Barrel” Stent Reconstruction of a Symptomatic Fusiform Basilar Artery Aneurysm: Case Report

Giant fusiform aneurysms of the basilar artery are associated with a high rate of morbidity and mortality. Treatment of these lesions can be difficult, especially when there are poor anatomic collaterals such as posterior communicating arteries. These lesions often have no acceptable treatment. The authors present a case of a patient with a symptomatic, fusiform basilar artery aneurysm successfully treated with a side-by-side (double-barrel), telescoping stent construct. A 56-year-old man presented with chief concerns of dysarthria and left-sided hemiparesis. MRI and conventional catheter-based angiography revealed a dolichoectatic basilar artery with 3 large fusiform aneurysms throughout its length. Flow through the patient's aneurysm was successfully reduced with a side-by-side stent construct and coiling of the proximal aneurysm dilation. The patient experienced stabilization of his ischemic events and neurologic recovery. A total of 6 Neurform-2 4.5 × 30-mm stents were navigated and positioned from the proximal posterior cerebral arteries to the distal vertebral arteries in a side-by-side (double-barrel), telescoping manner. These were deployed simultaneously by 2 operators to oppose the stent struts as well as the arterial wall. Next, the proximal aneurysmal dilation was coiled to near occlusion. Successful flow redirection and aneurysm thrombosis was observed. A novel, endovascular stenting technique for successfully treating symptomatic, giant basilar artery aneurysms is presented. This patient at 4 months was living independently with no further neurologic events or decline.

P-017 ‘Double barrel’ stent reconstruction of a symptomatic fusiform basilar artery aneurysm

Objective and importanceGiant fusiform aneurysms of the basilar artery are associated with a high rate of morbidity and mortality. Treatment of these lesions can be difficult especially when there are...

Thrombotic complications of a basilar artery aneurysm in a young adult with Pompe disease

Background Pompe disease or type 2 glycogen storage disease is an inherited condition that generally afflicts the heart and skeletal muscle. Nervous tissue involvement is known; however, the effect on cerebral vasculature is less well understood. Case Description The thrombotic complications of a fusiform basilar artery aneurysm in a young adult patient with Pompe disease is presented with complete CT, MRI, and angiographic findings. Conclusion We suggest that in young adult patients with Pompe disease, MRA screening of intracerebral vessels may be considered with the goal of potentially diagnosing thrombotic and thromboembolic complications.

M.P.2.07 Dilatative arteriopathy and basilar artery aneurysm complicating late-onset Pompe disease

Strokes related to intracranial aneurysm or arteriopathy have been reported in a few patients with late-onset Pompe disease. These reports suggested that cerebral vessels involvement could represent an under recognised complication of this disease. We report three French patients with late-onset Pompe disease and cerebral arteries involvement. Patient 1, was a 35-year-old woman who presented subacute headaches revealing a giant fusiform aneurysm of basilar artery. She subsequently developed intracranial hypertension and died suddenly 10days after a surgical intervention for ventriculo-peritoneal derivation.

THROMBOSIS OF A FUSIFORM INTRACRANIAL ANEURYSM INDUCED BY OVERLAPPING NEUROFORM STENTS

To present a case of a true fusiform basilar artery aneurysm that underwent spontaneous thrombosis after placement of two overlapping Neuroform stents (Boston Scientific/Target, Fremont, CA). A 45-year-old woman with transient syncopal episodes experienced a fall and presented to the emergency room. Incidentally, a non-contrast head computed tomographic scan and digital subtraction angiography demonstrated an unruptured, fusiform mid-basilar artery aneurysm. Endovascular treatment was initiated by using a stent-assisted coil embolization technique with placement of a self-expanding, dedicated intracranial, Neuroform stent in the basilar artery across the aneurysm's fusiform neck. Attempts to access the aneurysm for coil embolization resulted in transient migration of the stent into the aneurysm sac. A second Neuroform stent was advanced in telescoping fashion for salvage and stable coverage across the entire aneurysm; therefore, coil embolization was deferred to allow stent endothelialization. After 6 weeks on dual antiplatelet therapy, the patient presented with transient ischemic symptoms suggesting top of the basilar artery syndrome. Subsequent magnetic resonance imaging scans and angiography indicated circumferential thrombus formation in the aneurysm sac but patent flow in the basilar artery. A computed tomographic scan at 6 months and digital subtraction angiography at 12 months confirmed complete thrombosis of the fusiform mid-basilar artery aneurysm with basilar artery reconstruction. Overlapping Neuroform stents may induce spontaneous thrombosis of intracranial aneurysms and facilitate parent artery reconstruction through flow remodeling and stent endothelialization. Double stent placement may be a viable option in dissecting or fusiform intracranial aneurysms that are not amenable to open surgical treatment or endovascular coil embolization.

Fusiform Basilar Artery Aneurysm Rapid Death with Occlusion and Subdural-Subarachnoid Hemorrhage

Fusiform aneurysms of the posterior circulation constitute a relatively uncommon subgroup of aneurysms. We present a patient with fusiform basilar artery aneurysm accompanied by ectasia and elongation of both supraclinoid parts of the internal carotid arteries, middle cerebral arteries and vertebral arteries. The aneurysm had thrombus formation along its length which progressed to occlude the lumen the day after the patient's admission. Mass effect, progressive infarcts at the territories of posterior inferior cerebellar (PICA) and superior cerebellar (SCA) arteries and brainstem perforators along with subarachnoid and subdural hemorrhage were present.

Perfusion and Diffusion Tensor Imaging in a Patient with Locked-in Syndrome after Neurosurgical Vascular Bypass and Endovascular Embolization of a Basilar Artery Aneurysm: Case Report

Locked-in syndrome is a state of preserved consciousness in the setting of quadriplegia, anarthria, and usually also includes lateral gaze palsy. It is most commonly associated with upper brainstem infarction variably sparing the third cranial nerve nucleus. There are likely many etiologies that contribute to this clinical syndrome. These are incompletely understood, and the syndrome remains a rare but devastating complication that can occur after neurosurgical and neurovascular interventions. Advanced magnetic resonance imaging techniques such as perfusion and diffusion tensor imaging may help to elucidate the mechanism behind locked-in syndrome. To the authors' knowledge, there are no reports in the literature of perfusion and diffusion tensor findings in patients with this syndrome. A postprocedural case of locked-in syndrome is described with abnormalities on perfusion and diffusion tensor imaging in the absence of any changes in conventional magnetic resonance imaging. A 57-year-old man who presented with acute onset headache, ataxia, and other nonspecific symptoms was found on imaging to have a giant fusiform basilar artery aneurysm. A saphenous vein graft bypass between the proximal right external carotid artery and P2 segment of the right posterior cerebral artery followed immediately by endovascular embolization of the aneurysm sac and distal left vertebral artery was performed. Postprocedural angiography demonstrated patency of the bypass graft, and diffusion weighted imaging showed no evidence for acute brainstem infarction. Nevertheless, despite technically successful procedures and the absence of abnormalities on conventional magnetic resonance imaging, the patient developed quadriplegia and anarthria and remained in a locked-in state until he expired. Abnormalities were, however, seen on both perfusion and diffusion tensor imaging, where hypoperfusion, increased mean diffusivity, and decreased fractional anisotropy were observed in the ventral brainstem. The findings suggested a disruption of pontine white matter tracts. Advanced imaging techniques may allow us to image important microstructural changes that were previously not discernable and assist in the evaluation of patients with complex neurological sequelae such as locked-in syndrome.

Bilobed wide neck posterior cerebral artery aneurysm associated with fusiform basilar aneurysm, subarachnoid hemorrhage and chronic renal failure. A case report.

A 56 year-old woman presented with a ruptured bilobed wide neck aneurysm of the P2 segment of the PCA, atherosclerotic fusiform basilar artery aneurysm, subarachnoid bleeding with negative CT scan and chronic renal failure. She was managed by a cooperative approach involving neurosurgeons, neuroradiologist, neurointensivist, emergency room physicians, nurses and technicians. She underwent operation by proximal clipping for the aneurysm of the PCA. Postoperative neurological deficits include homonymous hemianopsia and ipsilateral third nerve palsy. The operation was performed through asubtemporal approach. At surgery, the aneurysm was located in the distal of the P2 segment of PCA, bilobed up and down, no definitive neck with small distal branches, and was treated by proximal clipping of the PCA aneurysm. The fusiform basilar artery aneurysm was severely atherosclerotic and left untouched. This is a rare case which required a high index of suspicion to detect subarachnoid bleeding from ruptured posterior fossa aneurysm, accurate prediction of the site of bleeding and the location of aneurysm location by conventional angiogram, MRI and MRA, and careful planned surgical strategy with the right approach for the P2 segment of the PCA aneurysm, complicated post operative care with airway management, triple H therapy, nutrition, additional measures and multiple hemodialysis.

Giant Fusiform Basilar Artery Aneurysm Causing Obstructive Hydrocephalus

A 58-year-old man presented with a sudden onset gait disturbance and urinary incontinence. Magnetic resonance (MR) imaging and MR angiography showed a fusiform basilar artery aneurysm, 2 cm in diameter and 5 cm long. The aneurysm was thrombosed except the ectatic basilar artery flowing through it. Compression of the cerebrospinal fluid (CSF) pathways caused obstructive hydrocephalus with resultant transependymal CSF leakage. Conventional angiography missed the aneurysm. A one-sided ventriculoperitoneal shunt was placed to treat the patient's hydrocephalus. The patient's symptoms improved after surgery. MR imaging and MR angiography were useful noninvasive methods of detecting the aneurysm, defining its relationship with surrounding structures, and determining the cause of the hydrocephalus.