Abstract
A 31-year-old female patient was suffering headaches, mainly occipital, for a year following childbirth. She presented with a 4-week history of spastic paresis on the right side (MRC 4/5) and paraesthesia down her left leg. An MRI scan demonstrated brainstem compression at the craniocervical junction secondary to an unruptured aneurysm of the V4 segment of the right vertebral artery (VA). A CTA confirmed a dilated intradural (V4) segment of the right VA with a multilobulated, fusiform, dissecting aneurysm, and a dominant right AICA-PICA. DSA further delineated the anatomy and demonstrated the right PICA to be originating from the caudal part of the aneurysm. Given the mass effect, a deconstructive treatment strategy was employed using a combination of coils and a detachable balloon. A follow-up MRI at 7 days confirmed successful right vertebral artery occlusion, with reduction in the mass effect on the brainstem.
There was retrograde filling of the PICA territory via the right AICA with no sequelae of ischemia or infarction. Six-month MRI follow-up confirmed continued vessel occlusion and a further reduction in the size of the aneurysm. The current treatment options for a dissecting aneurysm along the vertebral artery is the main focus of this chapter.
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Makalanda, H.L.D., Udani, S.D., McKenna, G., Wong, K., Bhogal, P. (2020). Vertebral Artery Aneurysm: Unruptured Dissecting Intradural Right Vertebral Artery Aneurysm with Brainstem Compression; Coil Occlusion of the Aneurysm and the Parent Artery with Resolution of the Mass Effect; Good Clinical Outcome with Long-Term Follow-up. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-77827-3_87
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