Neurointervention.  2022 Nov;17(3):195-199. 10.5469/neuroint.2022.00360.

Endovascular Coiling of Fenestrated Vertebrobasilar Cerebral Aneurysms

• Liao M
• Huynh K
• Cicilioni K
• Kumar RPP

• KMID: 2535956
• DOI: http://doi.org/10.5469/neuroint.2022.00360

Abstract

Fenestrated vertebrobasilar junction aneurysms are uncommon vascular lesions. Surgical intervention remains extremely challenging due to the deep location and complex anatomy with adjacent cranial nerves and perforator vessels. Endovascular approach is safer and generally accepted as the primary treatment method. Optimal angiographic projections with three-dimensional reconstructions to guide microcatheter selection remain vital to successfully treating aneurysms with challenging fenestration anatomy. This report details the endovascular methods in two cases of fenestrated vertebrobasilar junction aneurysms with different coiling techniques.

Keyword

Intracranial aneurysm; Vertebral artery; Basilar artery; Endovascular procedures; Stent

Figure

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  Fig. 1. Angiogram (A) and three-dimensional volume rendering (B) with obliqued view of case 1 demonstrating broad-based aneurysm arising from the vertebrobasilar artery proximal fenestration branchpoint with involvement of both fenestration branches. (C) Angiogram of case 1 following deployment of Neuroform Atlas stent through the dominant fenestration limb (arrow) across the aneurysm ostium. Additional microcatheter remains within non-dominant fenestration limb (arrowhead). (D) Coil deployment in case 1 via the dominant fenestration limb (arrow) through the Atlas stent interstices and (not shown) subsequently through the non-dominant fenestration limb (arrowhead). Thirteen-month surveillance cerebral angiogram in frontal (E) and lateral (F) views demonstrating no contrast opacification of the aneurysm and stable stent positioning.

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  Fig. 2. Angiogram (A) and three-dimensional (3D) volume rendering (B) of case 2 with obliqued view demonstrating narrow neck aneurysm arising from the vertebrobasilar artery proximal fenestration branchpoint, symmetric at bifurcation. Lateral view angiograms before (C) and following (D) primary coiling of case 2 with single microsystem. Eight-month surveillance cerebral angiograms in frontal (E) and lateral (F) views and 3D volume rendering (G) demonstrating contrast opacification of 1×2 mm neck remnant (arrows).

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