Korean J Radiol.  2005 Jun;6(2):125-129. 10.3348/kjr.2005.6.2.125.

Treatment of a Sequential Giant Fusiform Aneurysm of the Basilar Trunk

Affiliations
  • 1Department of Neurosurgery, Konkuk University Hospital, Korea. hanmh@radcom.snu.ac.kr
  • 2Department of Neurosurgery, Seoul National University College of Medicine, Korea.
  • 3Clinical Research Institute, Seoul National University Hospital, Korea.
  • 4Department of Radiology, Seoul National University College of Medicine, Korea.
  • 5Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

Abstract

We report an exceptional case of a de novo giant fusiform aneurysm of the basilar trunk, which developed shortly after the therapeutic occlusion of the right internal carotid artery for a fusiform carotid aneurysm. It would appear to be appropriate to call this entity a sequential giant fusiform aneurysm. The patient was successfully treated with endovascular occlusion of the giant basilar trunk aneurysm following bypass surgery.

Keyword

Basilar artery; Extracranial-intracranial bypass; Fusiform aneurysm; Giant aneurysm; Therapeutic embolization

MeSH Terms

Adult
Carotid Artery Diseases/therapy
Carotid Artery, Internal
Cerebral Angiography
Female
Humans
Intracranial Aneurysm/diagnosis/*surgery
Magnetic Resonance Imaging

Figure

  • Fig. 1 A. The AP view of a right internal carotid artery angiogram showing a giant fusiform aneurysm involving the petrous to cavernous parts in a 30-year-old woman. B. The vertebral angiogram shows the extremely tortuous course of the vertebrobasilar arteries without aneurysmal dilatation. C. The aneurysm is no longer visible on the lateral view of the right internal carotid artery angiogram after endovascular trapping.

  • Fig. 2 A. MR imaging, taken seven months after therapeutic occlusion of the right internal carotid artery, shows a large signal void in the basilar artery area, exerting a mass effect on the brain stem. B. Angiogram reveals a giant fusiform aneurysm of the basilar trunk, just distal to the origin of the left anterior inferior cerebellar artery.

  • Fig. 3 A. Angiogram, taken after the external carotid artery to middle cerebral artery bypass using the saphenous vein graft, shows a patent bypass and an adequate perfusion to the middle cerebral artery territory through the bypass. B. Test balloon occlusion at the level of the proximal basilar artery ensures adequate perfusion to the upper parts of the brain stem and cerebellum through the left posterior communicating artery. C. Angiogram, taken at the completion of embolization, shows near complete obliteration of the aneurysm.

  • Fig. 4 Angiograms taken three months (A) and one year (B) post-treatment show remarkable decreases in the volume of the aneurysm and in the degree of brainstem compression.


Reference

1. Rinne JK, Hernesniemi JA. De novo aneurysms: special multiple intracranial aneurysms. Neurosurgery. 1993. 33:981–985.
2. Johnston SC, Halbach VV, Smith WS, Gress DR. Rapid development of giant fusiform cerebral aneurysms in angiographically normal vessels. Neurology. 1998. 50:1163–1166.
3. Drake CG, Peerless SJ. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg. 1997. 87:141–162.
4. Anson JA, Lawton MT, Spetzler RF. Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg. 1996. 84:185–193.
5. Higashida RT, Smith W, Gress D, Urwin R, Dowd CF, Balousek PA, et al. Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg. 1997. 87:944–949.
6. Phatouros CC, Sasaki TY, Higashida RT, Malek AM, Meyers PM, Dowd CF, et al. Stent-supported coil embolization: the treatment of fusiform and wide-neck aneurysms and pseudoaneurysms. Neurosurgery. 2000. 47:107–113.
7. Islak C, Kocer N, Albayram S, Kizilkilic O, Uzma O, Cokyuksel O. Bare stent-graft technique: a new method of endoluminal vascular reconstruction for the treatment of giant and fusiform aneurysms. AJNR Am J Neuroradiol. 2002. 23:1589–1595.
8. Steinberg GK, Drake CG, Peerless SJ. Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg. 1993. 79:161–173.
9. Leibowitz R, Do HM, Marcellus ML, Chang SD, Steinberg GK, Marks MP. Parent vessel occlusion for vertebrobasilar fusiform and dissecting aneurysms. AJNR Am J Neuroradiol. 2003. 24:902–907.
10. Blanc R, Weill A, Piotin M, Ross IB, Moret J. Delayed stroke secondary to increasing mass effect after endovascular treatment of a giant aneurysm by parent vessel occlusion. AJNR Am J Neuroradiol. 2001. 22:1841–1843.
11. Halbach VV, Higashida RT, Dowd CF, Barnwell SL, Fraser KW, Smith TP, et al. The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg. 1994. 80:659–666.
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