Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Fusiform Aneurysm on the Basilar Artery Trunk Treated with Intra-Aneurysmal Embolization with Parent Vessel Occlusion after Complete Preoperative Occlusion Test

  • Jung, Young-Jin (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Kim, Min-Soo (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Choi, Byung-Yon (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Chang, Chul-Hoon (Department of Neurosurgery, College of Medicine, Yeungnam University)
  • Received : 2012.06.22
  • Accepted : 2013.04.08
  • Published : 2013.04.28
Download PDF
⟨ Previous Next ⟩

Abstract

Fusiform aneurysms on the basilar artery (BA) trunk are rare. The microsurgical management of these aneurysms is difficult because of their deep location, dense collection of vital cranial nerves, and perforating arteries to the brain stem. Endovascular treatment is relatively easier and safer compared with microsurgical treatment. Selective occlusion of the aneurysmal sac with preservation of the parent artery is the endovascular treatment of choice. But, some cases, particularly giant or fusiform aneurysms, are unsuitable for selective sac occlusion. Therefore, endovascular coiling of the aneurysm with parent vessel occlusion is an alternative treatment option. In this situation, it is important to determine whether a patient can tolerate parent vessel occlusion without developing neurological deficits. We report a rare case of fusiform aneurysms in the BA trunk. An 18-year-old female suffered a headache for 2 weeks. Computed tomography and magnetic resonance image revealed a fusiform aneurysm of the lower basilar artery trunk. Digital subtraction angiography revealed a $7.1{\times}11.0$ mm-sized fusiform aneurysm located between vertebrovasilar junction and the anterior inferior cerebellar arteries. We had good clinical result using endovascular coiling of unruptured fusiform aneurysm on the lower BA trunk with parent vessel occlusion after confirming the tolerance of the patient by balloon test occlusion with induced hypotension and accompanied by neurophysiologic monitoring, transcranial Doppler and single photon emission computed tomography. In this study, we discuss the importance of preoperative meticulous studies for avoidance of delayed neurological deficit in the patient with fusiform aneurysm on lower basilar trunk.

Keywords

References

  1. Aymard A, Gobin YP, Hodes JE, Bien S, Rüfenacht D, Reizine D, et al. : Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms. J Neurosurg 74 : 393-398, 1991 https://doi.org/10.3171/jns.1991.74.3.0393
  2. Boardman P, Byrne JV : Giant fusiform basilar artery aneurysm : endovascular treatment by flow reversal in the basilar artery. Br J Radiol 71 : 332-335, 1998 https://doi.org/10.1259/bjr.71.843.9616247
  3. Cloughesy TF, Nuwer MR, Hoch D, Vinuela F, Duckwiler G, Martin N : Monitoring carotid test occlusions with continuous EEG and clinical examination. J Clin Neurophysiol 10 : 363-369, 1993 https://doi.org/10.1097/00004691-199307000-00010
  4. Drake CG, Peerless SJ : Giant fusiform intracranial aneurysms : review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87 : 141-162, 1997 https://doi.org/10.3171/jns.1997.87.2.0141
  5. Eckert B, Thie A, Carvajal M, Groden C, Zeumer H : Predicting hemodynamic ischemia by transcranial Doppler monitoring during theraing peutic balloon occlusion of the internal carotid artery. AJNR Am J Neuroradiol 19 : 577-582, 1998
  6. Hassan T, Ezura M, Takahashi A : Treatment of giant fusiform aneurysms of the basilar trunk with intra-aneurysmal and basilar artery coil embolization. Surg Neurol 62 : 455-462; discussion 462, 2004 https://doi.org/10.1016/j.surneu.2004.01.020
  7. Higa T, Ujiie H, Kato K, Kamiyama H, Hori T : Basilar artery trunk saccular aneurysms : morphological characteristics and management. Neurosurg Rev 32 : 181-191; discussion 191, 2009 https://doi.org/10.1007/s10143-008-0163-3
  8. Higashida RT, Halbach VV, Cahan LD, Hieshima GB, Konishi Y : Detachable balloon embolization therapy of posterior circulation intracranial aneurysms. J Neurosurg 71 : 512-519, 1989 https://doi.org/10.3171/jns.1989.71.4.0512
  9. Lawton MT, Daspit CP, Spetzler RF : Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41 : 513-520; discussion 520-521, 1997
  10. Lesley WS, Bieneman BK, Dalsania HJ : Selective use of the paraophthalmic balloon test occlusion (BTO) to identify a false-negative subset of the cervical carotid BTO. Minim Invasive Neurosurg 49 : 34-36, 2006 https://doi.org/10.1055/s-2005-919149
  11. Linskey ME, Jungreis CA, Yonas H, Hirsch WL Jr, Sekhar LN, Horton JA, et al. : Stroke risk after abrupt internal carotid artery sacrifice : accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol 15 : 829-843, 1994
  12. Marshall RS, Lazar RM, Mohr JP, Pile-Spellman J, Hacein-Bey L, Duong DH, et al. : Higher cerebral function and hemispheric blood flow during awake carotid artery balloon test occlusions. J Neurol Neurosurg Psychiatry 66 : 734-738, 1999 https://doi.org/10.1136/jnnp.66.6.734
  13. Matsuda H, Yagishita A, Tsuji S, Hisada K : A quantitative approach to technetium-99m ethyl cysteinate dimer : a comparison with technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med 22 : 633-637, 1995 https://doi.org/10.1007/BF01254564
  14. Michael WF : Posterior fossa aneurysms simulating tumours. J Neurol Neurosurg Psychiatry 37 : 218-223, 1974 https://doi.org/10.1136/jnnp.37.2.218
  15. Omahen DA, Findlay JM : A giant fusiform basilar aneurysm treated by bilateral vertebral artery occlusion. J Clin Neurosci 11 : 324-328, 2004 https://doi.org/10.1016/j.jocn.2003.06.002
  16. Pelz DM, Viñuela F, Fox AJ, Drake CG : Vertebrobasilar occlusion therapy of giant aneurysms. Significance of angiographic morphology of the posterior communicating arteries. J Neurosurg 60 : 560-565, 1984 https://doi.org/10.3171/jns.1984.60.3.0560
  17. Pia HW : Classification of vertebro-basilar aneurysms. Acta Neurochir (Wien) 47 : 3-30, 1979 https://doi.org/10.1007/BF01404659
  18. Sorteberg A, Bakke SJ, Boysen M, Sorteberg W : Angiographic balloon test occlusion and therapeutic sacrifice of major arteries to the brain. Neurosurgery 63 : 651-660; dicussion 660-661, 2008 https://doi.org/10.1227/01.NEU.0000325727.51405.D5
  19. Standard SC, Ahuja A, Guterman LR, Chavis TD, Gibbons KJ, Barth AP, et al. : Balloon test occlusion of the internal carotid artery with hypotensive challenge. AJNR Am J Neuroradiol 16 : 1453-1458, 1995
  20. 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 https://doi.org/10.3171/jns.1993.79.2.0161
  21. Su CC, Watanabe T, Yoshimoto T, Ogawa A, Ichige A : Proximal clipping of dissecting intracranial vertebral aneurysm--effect of balloon Matas test with neurophysiological monitoring. Case report. Acta Neurochir (Wien) 104 : 59-63, 1990 https://doi.org/10.1007/BF01842895
  22. Tomura N, Omachi K, Takahashi S, Sakuma I, Otani T, Watarai J, et al. : Comparison of technetium Tc 99m hexamethylpropyleneamine oxime single-photon emission tomograph with stump pressure during the balloon occlusion test of the internal carotid artery. AJNR Am J Neuroradiol 26 : 1937-1942, 2005
  23. Uda K, Murayama Y, Gobin YP, Duckwiler GR, Vinuela F : Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils : clinical experience with 41 aneurysms in 39 patients. J Neurosurg 95 : 624-632, 2001 https://doi.org/10.3171/jns.2001.95.4.0624
  24. Van Rooij WJ, Sluzewski M, Menovsky T, Wijnalda D : Coiling of saccular basilar trunk aneurysms. Neuroradiology 45 : 19-21, 2003 https://doi.org/10.1007/s00234-002-0882-z
  25. Wang Q, Leng B, Song D, Chen G : Fusiform aneurysms of the vertebrobasilar arterial trunk : choice of endovascular methods and therapeutic efficacy. Acta Neurochir (Wien) 152 : 1467-1476, 2010 https://doi.org/10.1007/s00701-010-0691-9
  26. Yamamoto Y, Nishiyama Y, Toyama Y, Satoh K, Irie K, Ohkawa M : Preliminary results of Tc-99m ECD SPECT to evaluate cerebral collateral circulation during balloon test occlusion. Clin Nucl Med 27 : 633-637, 2002 https://doi.org/10.1097/00003072-200209000-00005

Cited by

  1. Arterial occlusion to treat basilar artery dissecting aneurysm vol.49, pp.2, 2015, https://doi.org/10.1016/j.pjnns.2015.02.003