Abstract
Purpose
Basilar artery is the second most common site of fenestration, after the anterior communicating region. It is believed this variation predisposes a patient to posterior aneurysm formation and increases the complexity of the surgical anatomy. Endovascular management has become the first option to treat these aneurysms. We retrospectively evaluated eight patients, who underwent endovascular treatment for fenestrated basilar artery related aneurysms (fBA-AN). Additionally, based on our findings and on literature review, we developed a treatment strategy based on a proposed classification of fBA-AN.
Methods
Between June 2010 and September 2012, eight patients harboring nine basilar artery fenestration aneurysms were consecutively treated. Based on aneurysm morphology (neck size) and its relationship to the fenestration (sparing or not one channel) characterized by 3D-DSA, we proposed a simple classification and treatment strategies. Additionally, a literature review was performed.
Results
All patients received endovascular treatment. Most aneurysms involved the vertebrobasilar junction and both channels of the fenestration. A total of 5 aneurysms had wide neck while 4 had narrow neck. Overall, 5 (55.5 %) aneurysms were treated with stent assisted coiling, 3 (33.3 %) aneurysms with selective coiling, and 1 (11.1 %) aneurysm with balloon assisted coiling. We had only 1 (11.1 %) complication, named aneurysm rupture.
Conclusion
Basilar artery fenestration aneurysms are rare and complex lesions. Endovascular treatment appears to be safe and efficient. The detailed understanding of the aneurysm morphology and its relation to the fenestration is strongly recommended to treatment planning. Further studies are necessary to validate the utility of the proposed classification and treatment strategy.
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References
Gao LY, Guo X, Zhou JJ, Zhang Q, Fu J, Chen WJ, Yang YJ. Basilar artery fenestration detected with CT angiography. Eur Radiol. 2013;23(10):2861–7.
Tanaka M, Kikuchi Y, Ouchi T. Neuroradiological analysis of 23 cases of basilar artery fenestration based on 2280 cases of MR angiographies. Interventional Neuroradiol. 2006; 12(Suppl 1):39–44.
Tanaka S, Tokimura H, Makiuchi T, Nagayama T, Takasaki K, Tomosugi T, Hirahara K, Yamahata H, Campos F, Nishizawa T, Arita K. Clinical presentation and treatment of aneurysms associated with basilar artery fenestration. J Clin Neurosci. 2012;19(3):394–401.
Saatci I, Cekirge HS, Karcaaltincaba M, Basgun N, Berker M, Timurkaynak E, Ozcan OE. Endovascular treatment of kissing aneurysms at the fenestrated basilar artery: case report with literature review. Surg Neurol. 2002;58:54–8.
Yoon SM, Chun YI, Kwun BD. Vertebrobasilar junction aneurysms associated with fenestration: experience of five cases treated with Guglielmi detachable coils. Surg Neurol. 2004;61:248–54.
Nagashima H, Okudera H, Orz Y, Kobayashi S, Nakagawa F. Endovascular treatment of basilar trunk aneurysm associated with fenestration of the basilar artery. Neurosurg Rev. 1999;22:219–21.
Islak C, Naci K, Kantarci F, Saatci I, Uzma O, Canbaz Bulent. Endovascular management of basilar artery aneurysms associated with fenestrations. AJNR Am J Neuroradiol. 2002;23:958–64.
Pierot L, Boulin A, Castaings L, Rey A, Moret J. Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery. 1996;38(5):948–54.
Nichols DA, Brown RD, Thielen KR, Meyer FB, Atkinson JLD, Piepgras DG. Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg. 1997;87:374–80.
Graves VB, Strother CM, Weir B, Duff TA. Vertebrobasilar junction aneurysms associated with fenestration: treatment with Guglielmi detachable coils. AJNR Am J Neuroradiol. 1996;17:35–40.
Kai Y, Hamada J, Morioka M, Yano S, Fujioka S, Kuratsu J. Endovascular treatment of ruptured aneurysms associated with fenestrated basilar artery – two case reports. Neurol Med Chir. (Tokyo) 2006;46:244–7.
Peluso JPP, van Rooij WJ, Sluzewski M, Beute GN. Aneurysms of the vertebrobasilar junction: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol. 2007;28:1747–51.
Albanese E, Russo A, Ulm AJ. Fenestrated vertebrobasilar junction aneurysm: diagnostic and therapeutic considerations. J Neurosurg. 2009;110:525–9.
Tasker AD, Byrne JV. Basilar artery fenestration in association with aneurysms of the posterior cerebral circulation. Neuroradiology. 1997;39:185–9.
Juszkat R, Nowak S, Moskal J, Kociemba W, Zarzecka A. Endovascular treatment of basilar artery aneurysms associated with distal fenestration – a case report. Interventional Neuroradiol. 2009;15:109–11.
Foroni LHL, Figueiredo EG, Teixeira MJ, Caldas JGMP, Leszczynski A, Rivau FR. Saccular aneurysms at middle basilar trunk fenestration. Arq Neuropsiquiatr. 2010;68(2):309–11.
Chung J, Park H, Lim YC, Hyun DK, Shin YS. Endovascular treatment of basilar artery trunk aneurysms. Acta Neurochir. 2011;153:2137–45.
Gruber TJ, Ogilvy CS, Hauck EF, Levy EI, Hopkins LN, Siddiqui AH. Endovascular treatment of a large aneurysm arising from a basilar trunk fenestration using the waffle-cone technique. Neurosurgery. 2010;67(3 Suppl Operative):ons140–44.
Alurkar A, Karanam LSP, Oak S. Endovascular treatment of ruptured saccular aneurysm from basilar artery fenestration. Neurol India. 2012;60:682–3.
Im SH, Kwon BJ, Jung C, Seo HS, Lee DH, Han MH. Coil embolization of “kissing aneurysms” associated with distal basilar artery fenestration. Clin Neurol Neurosurg. 2007;109(2):210–3.
Kan P, Abla AA, Dumont TM, Snyder KV, Hopkins LN, Levy EI, Siddiqui AH. Double-barrel stent-assisted coiling of a basilar artery fenestration aneurysm. J Neuroimaging. 2013;23:496–9.
Fujimoto K, Kawai S, Yonezawa T, Masui K, Nishi N, Maekawa M, Uranishi R. Basilar trunk aneurysms with associated fenestration treated by using Guglielmi detachable coils: two cases reports. J Stroke Cerebrovasc Dis. 2007;16(2):84–7.
Stark MM, Skeik N, Almandoz JED, Crandall BM, Tubman DE. Concurrent basilar artery diuble fenestration with aneurysm and vertebral artery dissection: case report and literature review of rare cerebrovascular abnormalities. Ann Vasc Surg. 2013;27(4):497.e15–21.
Krings T, Baccin CE, Alvarez H, Ozanne A, Stracke P, Lasjaunias PL. Segmental unfused basilar artery with kissing aneurysms: report of three cases and literature review. Acta Neurochir (Wien). 2007;149:567–74.
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We gratefully acknowledge Janaína Rezende for an invaluable assistance in preparing the drawings.
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Trivelato, F., Abud, D., Nakiri, G. et al. Basilar Artery Fenestration Aneurysms: Endovascular Treatment Strategies Based on 3D Morphology. Clin Neuroradiol 26, 73–79 (2016). https://doi.org/10.1007/s00062-014-0336-0
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DOI: https://doi.org/10.1007/s00062-014-0336-0