TY - JOUR
T1 - Progressive growth of a giant dolichoectatic vertebrobasilar artery aneurysm after complete Hunterian occlusion of the posterior circulation
T2 - Case report
AU - O'Shaughnessy, Brian A.
AU - Getch, Christopher C.
AU - Bendok, Bernard R.
AU - Parkinson, Richard J.
AU - Batjer, H. Hunt
AU - Lawton, Michael T.
AU - Barrow, Daniel L.
AU - Ogilvy, Christopher S.
PY - 2004/11/1
Y1 - 2004/11/1
N2 - OBJECTIVE AND IMPORTANCE: Dolichoectatic vertebrobasilar artery aneurysms are often extremely difficult, if not impossible, to treat with microneurosurgical clip reconstruction. As such, a Hunterian strategy via vertebral or basilar artery sacrifice is often used. We have encountered a patient in whom deliberate bilateral vertebral artery sacrifice was insufficient to avoid progressive expansion of a giant dolichoectatic vertebrobasilar artery aneurysm. On the basis of a review of the literature, we are unaware of another reported case. CLINICAL PRESENTATION: A 60-year-old man presented with signs and symptoms of brainstem compression from a large fusiform aneurysm involving the distal dominant vertebral and proximal basilar arteries. Results of angiographic evaluation were highly characteristic of underlying dolichoectasia. INTERVENTION: The patient was treated initially with staged bilateral vertebral artery occlusion and adjunctive posterior circulation revascularization. After this therapy failed, he underwent a trapping procedure and aneurysm deflation. CONCLUSION: Unclippable aneurysms of the vertebrobasilar system are formidable lesions. They are not uniformly treatable by direct surgical reconstruction, and their growth is not consistently stabilized by the implementation of a complete Hunterian strategy. Future developments related to the use of endovascular stent technology may offer a more successful treatment approach for patients with these complex cerebrovascular lesions.
AB - OBJECTIVE AND IMPORTANCE: Dolichoectatic vertebrobasilar artery aneurysms are often extremely difficult, if not impossible, to treat with microneurosurgical clip reconstruction. As such, a Hunterian strategy via vertebral or basilar artery sacrifice is often used. We have encountered a patient in whom deliberate bilateral vertebral artery sacrifice was insufficient to avoid progressive expansion of a giant dolichoectatic vertebrobasilar artery aneurysm. On the basis of a review of the literature, we are unaware of another reported case. CLINICAL PRESENTATION: A 60-year-old man presented with signs and symptoms of brainstem compression from a large fusiform aneurysm involving the distal dominant vertebral and proximal basilar arteries. Results of angiographic evaluation were highly characteristic of underlying dolichoectasia. INTERVENTION: The patient was treated initially with staged bilateral vertebral artery occlusion and adjunctive posterior circulation revascularization. After this therapy failed, he underwent a trapping procedure and aneurysm deflation. CONCLUSION: Unclippable aneurysms of the vertebrobasilar system are formidable lesions. They are not uniformly treatable by direct surgical reconstruction, and their growth is not consistently stabilized by the implementation of a complete Hunterian strategy. Future developments related to the use of endovascular stent technology may offer a more successful treatment approach for patients with these complex cerebrovascular lesions.
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U2 - 10.1227/01.NEU.0000140987.71791.DF
DO - 10.1227/01.NEU.0000140987.71791.DF
M3 - Article
C2 - 15791739
AN - SCOPUS:8744291889
SN - 0148-396X
VL - 55
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -