Successful treatment of a ruptured dissecting basilar artery aneurysm

Case report

View More View Less
  • 1 Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ Dissecting basilar artery (BA) aneurysms in patients presenting with subarachnoid hemorrhage are life threatening, especially in those who experience subsequent bleeding or progressive dissection, and immediate surgical or endovascular intervention may be necessary. The authors report on a 52-year-old woman whose dissecting BA aneurysm was treated successfully with proximal occlusion and flow reversal. Clipping of the proximal BA above the level of the anterior inferior cerebellar arteries facilitated retrograde flow from a radial artery graft placed between the left vertebral artery and the left posterior cerebral artery, thereby providing continuous perfusion of the BA and its branches. Postoperative angiograms obtained 1 year later revealed good retrograde flow through the BA and dilation of the radial arterial graft. There were no episodes of recurrent hemorrhage.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Yutaka Kai, M.D., Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, 1–1–1 Honjo, Kumamoto 860–8556, Japan. email: ykai@kaiju.medic.kumamoto-u.ac.jp.
  • 1.

    Amin-Hanjani S, , Ogilvy CS, & Buonanno FS, et al: Treatment of dissecting basilar artery aneurysm by flow reversal. Acta Neurochir 139:4451, 1997 Amin-Hanjani S, Ogilvy CS, Buonanno FS, et al: Treatment of dissecting basilar artery aneurysm by flow reversal. Acta Neurochir 139:44–51, 1997

    • Search Google Scholar
    • Export Citation
  • 2.

    Archer CR, & Horenstein S: Basilar artery occlusion: clinical and radiological correlation. Stroke 8:383390, 1977 Archer CR, Horenstein S: Basilar artery occlusion: clinical and radiological correlation. Stroke 8:383–390, 1977

    • Search Google Scholar
    • Export Citation
  • 3.

    Berger MS, & Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882894, 1984 Berger MS, Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894, 1984

    • Search Google Scholar
    • Export Citation
  • 4.

    Berkovic SF, , Spokes RL, & Anderson RM, et al: Basilar artery dissection. J Neurol Neurosurg Psychiatry 46:126129, 1983 Berkovic SF, Spokes RL, Anderson RM, et al: Basilar artery dissection. J Neurol Neurosurg Psychiatry 46:126–129, 1983

    • Search Google Scholar
    • Export Citation
  • 5.

    Caplan LR: Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome. Stroke 10:277282, 1979 Caplan LR: Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome. Stroke 10:277–282, 1979

    • Search Google Scholar
    • Export Citation
  • 6.

    Deck JH: Pathology of spontaneous dissection of intracranial arteries. Can J Neurol Sci 14:8891, 1987 Deck JH: Pathology of spontaneous dissection of intracranial arteries. Can J Neurol Sci 14:88–91, 1987

    • Search Google Scholar
    • Export Citation
  • 7.

    Drake CG: Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg 43:255274, 1975 Drake CG: Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg 43:255–274, 1975

    • Search Google Scholar
    • Export Citation
  • 8.

    Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96144, 1979 Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96–144, 1979

    • Search Google Scholar
    • Export Citation
  • 9.

    Farrell MA, , Gilbert JJ, & Kaufmann JC: Fatal intracranial arterial dissection: clinical pathological correlation. J Neurol Neurosurg Psychiatry 48:111121, 1985 Farrell MA, Gilbert JJ, Kaufmann JC: Fatal intracranial arterial dissection: clinical pathological correlation. J Neurol Neurosurg Psychiatry 48:111–121, 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Fields WS, , Ratinov G, & Weibel J, et al: Survival following basilar artery occlusion. Arch Neurol 15:463471, 1966 Fields WS, Ratinov G, Weibel J, et al: Survival following basilar artery occlusion. Arch Neurol 15:463–471, 1966

    • Search Google Scholar
    • Export Citation
  • 11.

    Friedman AH, & Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325334, 1984 Friedman AH, Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334, 1984

    • Search Google Scholar
    • Export Citation
  • 12.

    Heros RC, & Ameri AM: Rupture of a giant basilar aneurysm after saphenous vein interposition graft to the posterior cerebral artery. Case report. J Neurosurg 61:387390, 1984 Heros RC, Ameri AM: Rupture of a giant basilar aneurysm after saphenous vein interposition graft to the posterior cerebral artery. Case report. J Neurosurg 61:387–390, 1984

    • Search Google Scholar
    • Export Citation
  • 13.

    Hopkins LN, , Budny JL, & Castellani D: Extracranial-intracranial arterial bypass and basilar artery ligation in the treatment of giant basilar artery aneurysms. Neurosurgery 13:189194, 1983 Hopkins LN, Budny JL, Castellani D: Extracranial-intracranial arterial bypass and basilar artery ligation in the treatment of giant basilar artery aneurysms. Neurosurgery 13:189–194, 1983

    • Search Google Scholar
    • Export Citation
  • 14.

    Hosoda K, , Fujita S, & Kawaguchi T, et al: Spontaneous dissecting aneurysms of the basilar artery presenting with a subarachnoid hemorrhage. Report of two cases. J Neurosurg 75:628633, 1991 Hosoda K, Fujita S, Kawaguchi T, et al: Spontaneous dissecting aneurysms of the basilar artery presenting with a subarachnoid hemorrhage. Report of two cases. J Neurosurg 75:628–633, 1991

    • Search Google Scholar
    • Export Citation
  • 15.

    Kaku Y, , Yoshimura S, & Yamakawa H, et al: Failure of stent-assisted endovascular treatment for ruptured dissecting aneurysms of the basilar artery. Neuroradiology 45:2226, 2003 Kaku Y, Yoshimura S, Yamakawa H, et al: Failure of stent-assisted endovascular treatment for ruptured dissecting aneurysms of the basilar artery. Neuroradiology 45:22–26, 2003

    • Search Google Scholar
    • Export Citation
  • 16.

    Kashiwagi S, , Tew JM Jr, & van Loveren HR, et al: Trapping of giant basilar trunk aneurysms. Report of two cases. J Neurosurg 69:442445, 1988 Kashiwagi S, Tew JM Jr, van Loveren HR, et al: Trapping of giant basilar trunk aneurysms. Report of two cases. J Neurosurg 69:442–445, 1988

    • Search Google Scholar
    • Export Citation
  • 17.

    Kawaguchi S, , Sakaki T, & Tsunoda S, et al: Management of dissecting aneurysms of the posterior circulation. Acta Neurochir 131:2631, 1994 Kawaguchi S, Sakaki T, Tsunoda S, et al: Management of dissecting aneurysms of the posterior circulation. Acta Neurochir 131:26–31, 1994

    • Search Google Scholar
    • Export Citation
  • 18.

    Mizutani T: A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg 84:962971, 1996 Mizutani T: A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg 84:962–971, 1996

    • Search Google Scholar
    • Export Citation
  • 19.

    Mizutani T, , Aruga T, & Kirino T, et al: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905913, 1995 Mizutani T, Aruga T, Kirino T, et al: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–913, 1995

    • Search Google Scholar
    • Export Citation
  • 20.

    Moscow NP, & Newton TH: Angiographic implications in diagnosis and prognosis of basilar artery occlusion. AJR 119:597604, 1973 Moscow NP, Newton TH: Angiographic implications in diagnosis and prognosis of basilar artery occlusion. AJR 119:597–604, 1973

    • Search Google Scholar
    • Export Citation
  • 21.

    Pozzati E, , Andreoli A, & Limoni P, et al: Dissecting aneurysms of the vertebrobasilar system: study of 16 cases. Surg Neurol 41:119124, 1994 Pozzati E, Andreoli A, Limoni P, et al: Dissecting aneurysms of the vertebrobasilar system: study of 16 cases. Surg Neurol 41:119–124, 1994

    • Search Google Scholar
    • Export Citation
  • 22.

    Pozzati E, , Andreoli A, & Padovani R, et al: Dissecting aneurysms of the basilar artery. Neurosurgery 36:254258, 1995 Pozzati E, Andreoli A, Padovani R, et al: Dissecting aneurysms of the basilar artery. Neurosurgery 36:254–258, 1995

    • Search Google Scholar
    • Export Citation
  • 23.

    Pozzati E, , Padovani R, & Fabrizi A, et al: Benign arterial dissections of the posterior circulation. J Neurosurg 75:6972, 1991 Pozzati E, Padovani R, Fabrizi A, et al: Benign arterial dissections of the posterior circulation. J Neurosurg 75:69–72, 1991

    • Search Google Scholar
    • Export Citation
  • 24.

    Ross GJ, , Ferraro F, & DeRiggi L, et al: Spontaneous healing of basilar artery dissection: MR findings. J Comput Assist Tomogr 18:292294, 1994 Ross GJ, Ferraro F, DeRiggi L, et al: Spontaneous healing of basilar artery dissection: MR findings. J Comput Assist Tomogr 18:292–294, 1994

    • Search Google Scholar
    • Export Citation
  • 25.

    Schomer DF, , Marks MP, & Steinberg GK, et al: The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med 330:15651570, 1994 Schomer DF, Marks MP, Steinberg GK, et al: The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med 330:1565–1570, 1994

    • Search Google Scholar
    • Export Citation
  • 26.

    Shrontz C, , Dujovny M, & Ausman JI, et al: Surgical anatomy of the arteries of the posterior fossa. J Neurosurg 65:540544, 1986 Shrontz C, Dujovny M, Ausman JI, et al: Surgical anatomy of the arteries of the posterior fossa. J Neurosurg 65:540–544, 1986

    • Search Google Scholar
    • Export Citation
  • 27.

    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 79:161173, 1993 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 79:161–173, 1993

    • Search Google Scholar
    • Export Citation
  • 28.

    Sundt TM Jr, , Piepgras DG, & Houser OW, et al: Interposition saphenous vein grafts for advanced occlusive disease and large aneurysms in the posterior circulation. J Neurosurg 56:205215, 1982 Sundt TM Jr, Piepgras DG, Houser OW, et al: Interposition saphenous vein grafts for advanced occlusive disease and large aneurysms in the posterior circulation. J Neurosurg 56:205–215, 1982

    • Search Google Scholar
    • Export Citation
  • 29.

    Takagi M, , Hirata K, & Fujitsu K, et al: Unusual angiographic changes in a dissecting aneurysm of the basilar artery: case report. Neurosurgery 34:356358, 1994 Takagi M, Hirata K, Fujitsu K, et al: Unusual angiographic changes in a dissecting aneurysm of the basilar artery: case report. Neurosurgery 34:356–358, 1994

    • Search Google Scholar
    • Export Citation
  • 30.

    Wakui K, , Kobayashi S, & Takemae T, et al: Giant thrombosed vertebral artery aneurysm managed with extracranial-intracranial bypass surgery and aneurysmectomy. Case report. J Neurosurg 77:624627, 1992 Wakui K, Kobayashi S, Takemae T, et al: Giant thrombosed vertebral artery aneurysm managed with extracranial-intracranial bypass surgery and aneurysmectomy. Case report. J Neurosurg 77:624–627, 1992

    • Search Google Scholar
    • Export Citation
  • 31.

    Willing SJ, , Skidmore F, & Donaldson J, et al: Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement: report of two cases. AJNR 24:985989, 2003 Willing SJ, Skidmore F, Donaldson J, et al: Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement: report of two cases. AJNR 24:985–989, 2003

    • Search Google Scholar
    • Export Citation
  • 32.

    Woimant F, & Spelle L: Spontaneous basilar artery dissection: contribution of magnetic resonance imaging to diagnosis. J Neurol Neurosurg Psychiatry 58:540, 1995 Woimant F, Spelle L: Spontaneous basilar artery dissection: contribution of magnetic resonance imaging to diagnosis. J Neurol Neurosurg Psychiatry 58:540, 1995

    • Search Google Scholar
    • Export Citation
  • 33.

    Yaşargil MG, , Antic J, & Laciga R, et al: Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol 6:8391, 1976 Yaşargil MG, Antic J, Laciga R, et al: Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol 6:83–91, 1976

    • Search Google Scholar
    • Export Citation

Metrics