Giant Basilar Tip Aneurysm Research Articles

Successful clipping of A Gaint Basilar Tip Aneurysm: A Case Report with Review of literature

Basilar tip aneurysm is the commonest aneurysm in posterior circulation. It comprises of about 5% of total aneurysms of cerebral circulation. Giant basilar tip aneurysm is rare and is technically challenging. Bigger is the aneurysm more complex is its structure leading to technical difficulty in its treatment, may it be surgical clipping or endovascular coiling.We present 50-year-old male patient presented with sudden and severe headache with altered consciousness. CT head showed sub arachnoid hemorrhage and CT angiography showed giant basilar tip aneurysm measuring more than 23 mm in length. Moreover basilar tip bifurcation and both the posterior cerebral artery arose from posterior aspect of lower part of the trunk of aneurysm. Because of the huge size and origin of the major branches from aneurysm trunk surgical clipping seemed highly risky. Patient was planned for coil embolization in India. But due to cost factor surgical clipping was planned.Successful clipping was done through right frontotemporal transtentorial approach. Small residual aneurysm was noted in the anterior lower part of aneurysm trunk which was wrapped with hemostatic agents. Complete resection of the aneurysm was done showing complete obliteration of the aneurysm. Post operatively patient was neurologically intact except ipsilateral oculomotor nerve palsy.Patient was discharged on 6th post operative day.Nepal still lacks endovascular coiling facility. Cost factor is a major hindrance for this. Surgical clipping is still the fi rst choice of treatment for any aneurysm in Nepal. There is no alternative to skill development and successful clipping for treating aneurysm in Nepal.Nepal Journal of Neuroscience 12:40-42, 2015

コイル塞栓術後に血栓化巨大脳動脈瘤となった脳底動脈先端部脳動脈瘤の1例

We report a case of thrombotic giant basilar-tip aneurysm after coil embolization. A 59-year-old man had been treated with coil embolization of a ruptured basilar-tip aneurysm five years earlier. The aneurysm enlarged with a thrombotic component and compressed the midbrain, presenting with bilateral oculomotor palsy and ataxia. We performed re-embolization using a vascular reconstructive device in the hope of inhibiting neovascularization in the intra-aneurysmal thrombus by isolating the residual lumen. At two-year follow-up, the aneurysm had not expanded further and symptoms had not exacerbated.

Abstract 3708: Safety and Efficacy of Antiplatelet Monotherapy (clopidogrel) in Stent Assisted Elective Coil Embolization of Cerebral Aneurysms

BACKGROUND AND PURPOSE: Thromboembolic events are the most common complication seen in elective coil embolization of cerebral aneurysms. Previous studies have shown that administration of oral clopidogrel and/or aspirin may lower the thromboembolic complication rate but little data exists regarding clinical outcome with the use of antiplatelet monotherapy in stent assisted elective aneurysm coil embolization. Objectives: To assess the safety and efficacy of antiplatelet monotherapy (clopidogrel) in elective stent assisted coil embolization of cerebral aneurysms MATERIALS AND METHODS: Retrospective chart review was performed in 94 consecutive patients who underwent endovascular treatments for elective coil embolization of cerebral aneurysms between 2008-2010. Thirty patients were included in this study who met the inclusion criteria of stent assisted coil embolization. All these patients received 75mg clopidogrel for one week prior to the procedure. Clopidogrel was continued post procedure for six to eight weeks. Primary outcome measure was peri-procedure and post-procedure symptomatic thromboembolic complications. RESULTS The study included 23 females and 7 males with mean age 52.6 years.Twenty (66.7%) patients had anterior circulation aneurysms and 10 (33.3%) patients had posterior circulation aneurysms. Twenty (66.7%) patients were treated with Neuroform, 9 (30%) patients with Enterprise stent and 1 (3.3%) patient was treated with both Neuroform and Enterprise stent assisted coil embolization. One (3.3%) patient had an iatrogenic flow limiting vertebral artery dissection during embolization of vertebrobasilar artery aneurysm with no clinical deficit. The patient’s vertebral artery dissection was treated with 2 Wingspan stents and 1 Medtronic driver stents. Symptomatic thromboembolic complication was seen in 1 patient (3.3%) at discharge. The patient had a giant basilar tip aneurysm which was treated with stent assisted coil embolization. Postprocedure the patient had a right facial palsy with gaze deviation. The MRI was consistent with acute posterior circulation stroke. The patient was discharged home with a modified Rankin Scale <2. Follow up at six to eight weeks post procedure clinical data was available for 21 patients (73.3%). No delayed thromboembolic complication was observed in these patients at follow up visit. CONCLUSION: Oral clopidogrel is safe and efficacious as an antiplatelet monotherapy during elective stent assisted coil embolization. Further multicenter prospective trials are warranted to evaluate safety and efficacy of clopidogrel as a monotherapy for elective stent assisted coil embolization.

Embolization of a Wide Neck Giant Basilar Tip Aneurysm Using Two Coils

Pictorial demonstration of aneurysm lumen thrombosis and diversion of flow hemodynamics with the use of a minimum number of coils in the treatment of hemorrhagic basilar tip aneurysm. We present a 62-year-old lady who underwent endovascular treatment for acute subarachnoid hemorrhage due to a giant basilar tip aneurysm and a left carotico-ophthalmic aneurysm. Following deployment of two of the longest available coils, the procedure was terminated due to a sudden change of jet flow within the aneurysm and unsustainable coil and microcatheter positions in spite of further attempts. Post-procedural follow-up angiogram on day 22, revealed an approximately 90% occlusion of the giant basilar tip aneurysm. Significant reduction in flow dynamic by minimum number of coils can achieve remarkable and near complete thrombosis and occlusion of a giant basilar tip aneurysm.

Light aneurismal coiling with satisfactory obliteration on follow up, a case report, is it a matter of full compaction or flow dynamic changes?

Aims: The demonstration of aneurysm lumen thrombosis and with satisfactory diversion of flow hemodynamics with the use of a minimum number of coils in the treatment of hemorrhagic cerebral aneurysms. Hence attracting the attention to the importance of flow dynamic changes as predictor of successful aneurysm obliteration. . However I would not suggest partial coiling of aneurysms as a preferred treatment modality for these malignant lesions. Case:We present a 59-year-old male teacher who underwent endovascular treatment for acute subarachnoid haemorrhage due to a giant basilar tip aneurysm (BTA) and left ophthalmic aneurysm. Following deployment of two of the longest available coils, the procedure was terminated due to a sudden change of jet flow within the aneurysm and unsustainable coil positions in spite of further attempts. Post-procedural follow-up angiograms in day 30 revealed an approximately total occlusion of the giant basilar tip aneurysm.Imaging/ Discussion:Significant change in flow dynamics by minimum number of coils can achieve significant flow reduction and near complete thrombosis and occlusion of a giant basilar tip aneurysm.

Basilar tip aneurysm – adenosine induced asystole for the treatment of a basilar tip aneurysm following failure of temporary clipping

We report on a giant basilar tip aneurysm in a 48-year-old woman that could not be clipped despite temporary occlusion of the basilar trunk. Adenosine induced cardiac asystole reduced the aneurysm's wall tension and coupled with increased exposure resulting from brain relaxation allowed for the aneurysm to be satisfactorily occluded via an extended right pterional craniotomy. In difficult vascular cases, adenosine induced cardiac standstill is a useful technique which may allow for technical success when other methods such as temporary clipping fail. It acts to both reduce aneurysm wall tension and increase operative exposure by reducing vascular, and hence brain volume.

Successful “blind-alley” formation with bypass surgery for a partially thrombosed giant basilar artery tip aneurysm refractory to upper basilar artery obliteration

Partially thrombosed giant aneurysms that are located at the basilar artery (BA) bifurcation and are not amenable to clip application are among the most challenging lesions for neurosurgeons. They compress vital structures such as the brainstem and the thalamus, and the prognosis is extremely poor when they are left untreated. Although obliteration of the upper BA is a promising approach for these aneurysms, some lesions are refractory to this treatment, and effective additional strategies have not been clearly established. The authors report a case treated by placement of clips in the unilateral posterior cerebral artery (PCA) and posterior communicating artery as well as by superficial temporal artery-PCA bypass after unsuccessful upper BA obliteration. Complete thrombosis and dramatic shrinkage of the aneurysm were obtained.

Spontaneous Healing and Complete Disappearance of a Giant Basilar Tip Aneurysm in a Child

We report a rare case of spontaneous total thrombosis of a giant basilar tip aneurysm resulting in compression of the brainstem, diagnosed in a two-year-old child who presented with neurological deficits and third cranial nerve impairment. After conservative treatment, the giant aneurysm was completely thrombosed and the clinical symptoms were remarkably improved. MRI demonstrated dramatic shrinkage and ultimately complete disappearance of the giant aneurysm at seven month follow-up.

Spontaneous Occlusion of a Giant Basilar Tip Aneurysm and a Basilar Artery Due to the Dissection of Both Structures: Case Report

Background Spontaneous occlusion of a giant aneurysm with its parent artery is relatively rare. Complete occlusion of a giant aneurysm at the basilar bifurcation and a basilar artery due to the dissection of the basilar artery has never been reported. Case Description This 62-year-old man presented with left hemiparesis and right oculomotor palsy. Radiographic study showed a giant aneurysm at the basilar artery bifurcation with hemorrhage in its wall and an ischemic area in the right midbrain. Subsequent study revealed that thrombosis of the aneurysm rapidly progressed and that the parent basilar artery caused the dissection. Finally the giant aneurysm and the basilar artery were completely thrombosed. Conclusion The dissection was considered to occur in the aneurysm wall first by the hemorrhage in it and progress proximally along the basilar artery. Intramural hemorrhage in the wall of a giant aneurysm can be a cause of dissection of its parent artery. This seems to be one of the mechanisms by which a giant aneurysm and its parent artery are spontaneously thrombosed.

Foramen Monroi - Blockade durch ein Riesenaneurysma der Arteria basilaris*

A case of a giant aneurysma of the basilar artery bifurcation with occlusive hydrocephalus due to bilateral foramen of Monro occlusion is reported. The patient presented with progressive neurological deterioration which led to computerized tomography examination and implantation of a ventricular shunt as an emergency procedure. After the patient had recovered to a certain extent, four-vessel angiography was performed that demonstrated a giant basilar tip aneurysm. As the posterior communicating, the posterior cerebral as well as the superior cerebellar arteries originated from the aneurysm sac direct surgical attack as well as endovascular treatment was considered to be impossible. A permanent biventricular-abdominal shunt system was implanted and the patient was discharged. Three weeks later the patient was readmitted comatose after he had suffered a massive subarachnoid hemorrhage from which he finally died. The clinical and radiological signs, the differential-diagnostic considerations as well as the few cases of foramen of Monro occlusion by a giant basilar artery tip aneurysm, presented in the literature so far, are discussed.