Skip to main content
SpringerLink
Log in

Endovascular treatment of basilar artery trunk aneurysms

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

There has been little reported on the endovascular experience of basilar artery (BA) trunk aneurysms due to its low incidence. The purpose of this study is to report the results of endovascular treatment (EVT) of BA trunk aneurysms.

Methods

Between 2004 and 2008, eight BA trunk aneurysms were treated by EVT. Five patients presented with subarachnoid hemorrhage, one had intracranial mass effect, and in two of the patients the aneurysms were found incidentally. Four lesions were saccular aneurysms, three of them were found with BA fenestration. Three lesions were dissecting aneurysms and one was a giant fusiform aneurysm. The mean follow-up period of clinical outcome was 17.1 months (range, 6–32 months). Angiographic follow-up data was obtained in six patients for period of a mean of 15.6 months (range, 6–25 months).

Results

Four patients with saccular aneurysms were treated by stent-assisted coil embolization except for one patient that was treated without a stent. Three patients with dissecting aneurysms were treated by a single stent placement. One of these dissecting aneurysms rebled in 4 days after stent placement and was secured by BA occlusion. One giant fusiform aneurysm was treated by bilateral vertebral artery (VA) occlusion after balloon test occlusion. Six patients (75.0%) had excellent or good clinical outcomes, one patient whose aneurysm rebled became vegetative, and one patient with bilateral VA occlusion died. Follow-up angiograms showed that four lesions had complete occlusion and two had neck remnant.

Conclusions

The endovascular catheterization of these lesions tends to be relatively simple compared to more complex neurosurgical approaches. EVT, especially using a stent, could be a valuable therapeutic method in treating BA trunk aneurysms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Albuquerque FC, Fiorella DJ, Han PP, Deshmukh VR, Kim LJ, McDougall CG (2005) Endovascular management of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus 18:E3

    PubMed  Google Scholar 

  2. Anxionnat R, de Melo Neto JF, Bracard S, Bracard S, Lacour JC, Civit T, Picard L (2003) Treatment of hemorrhagic intracranial dissections. Neurosurgery 53:289–301

    Article  PubMed  Google Scholar 

  3. Aziz KMA, van Loveren HR, Tew JM Jr, Chicoine MR (1999) The Kawase approach to retrosellar and upper clival basilar aneurysms. Neurosurgery 44:1225–1236

    PubMed  Google Scholar 

  4. Benndorf G, Herbon U, Sollmann WP, Campi A (2001) Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 22:1844–1848

    PubMed  CAS  Google Scholar 

  5. Biondi A, Janardhan V, Katz JM, Salvaggio K, Riina HA, Gobin YP (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–469

    Article  PubMed  Google Scholar 

  6. Campos J, Fox AJ, Vinuela F, Lylyk P, Ferguson GG, Drake CG, Peerless SJ (1987) Saccular aneurysms in basilar artery fenestration. AJNR Am J Neuroradiol 8:233–236

    PubMed  CAS  Google Scholar 

  7. Doerfler A, Wanke I, Eqelhof T, Stolke D, Forsting M (2004) Double stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100:150–154

    Article  PubMed  Google Scholar 

  8. Fiorella D, Albuquerque FC, Deshmukh VR, Woo HH, Rasmussen PA, Masaryk TJ, McDougall CG (2006) Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:291–300

    Article  PubMed  Google Scholar 

  9. Fiorella D, Kelly ME, Albuquerque FC, Nelson PK (2009) Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device. Neurosurgery 64:212–217

    Article  PubMed  Google Scholar 

  10. Fiorella D, Woo HH, Albuquerque FC, Nelson PK (2008) Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62:1115–1121

    Article  PubMed  Google Scholar 

  11. Hassan T, Ezura M, Takahashi A (2004) Treatment of giant fusiform aneurysms of the basilar trunk with intra-aneurysmal and basilar artery coil embolization. Surg Neurol 62:455–462

    Article  PubMed  Google Scholar 

  12. He M, Zhang H, Lei D, Mao BY, You C, Xie XD, Sun H, Ju Y, Zhang JM (2009) Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms. J Neurosurg 110:418–426

    Article  PubMed  Google Scholar 

  13. Hemesniemi J, Vapalahti M, Niskanen M, Kari A (1992) Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31:857–862

    Article  Google Scholar 

  14. Higa T, Ujiie H, Kato K, Kamiyama H, Hori T (2009) Basilar artery trunk saccular aneurysms: morphological characteristics and management. Neurosurg Rev 32:181–191

    Article  PubMed  Google Scholar 

  15. Higashida RT, Halbach VV, Dowd CF, Juravsky L, Meagher S (2005) Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: The Cordis Enterprise stent. AJNR Am J Neuroradiol 26:1751–1756

    PubMed  Google Scholar 

  16. Hillman J, Saveland H, Jakobsson KE, Edner G, Zygmunt S, Fridriksson S, Brandt L (1996) Overall management outcome of ruptured posterior fossa aneurysms. J Neurosurg 85:33–38

    Article  PubMed  CAS  Google Scholar 

  17. Horie N, Kitagawa N, Morikawa M, Kawakubo J, Tsutsumi K, Kaminogo M, Nagata I (2007) Giant thrombosed fusiform aneurysm at the basilar trunk successfully treated with endovascular coil occlusion following bypass surgery: a case report and review of the literature. Neurol Res 29:842–846

    Article  PubMed  Google Scholar 

  18. Im SH, Kwon BJ, Jung C, Seo HS, Lee DH, Han MH (2007) Coil embolization of “kissing aneurysms” associated with distal basilar artery fenestration. Clin Neurol Neurosrug 109:210–213

    Article  Google Scholar 

  19. Islak C, Kocer N, Kantarci F, Saatci I, Uzma O, Canbaz B (2002) Endovascular management of basilar artery aneurysms associated with fenestrations. AJNR Am J Neuroradiol 23:958–964

    PubMed  Google Scholar 

  20. Kim BM, Suh SH, Park SI, Shin YS, Chung EC, Lee MH, Kim EJ, Koh JS, Kang HS, Roh HG, Won YS, Chung PW, Kim YB, Suh BC (2008) Management and clinical outcome of acute basilar artery dissection. AJNR Am J Neuroradiol 29:1937–1941

    Article  PubMed  CAS  Google Scholar 

  21. Lawton MT, Daspit PD, Spetzler RF (1997) Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41:513–521

    PubMed  CAS  Google Scholar 

  22. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2001) Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94:427–432

    Article  PubMed  CAS  Google Scholar 

  23. Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: The Buenos Aires experience. Neurosurgery 64:632–643

    Article  PubMed  Google Scholar 

  24. Martin NA (1997) Basilar trunk aneurysm: surgical technique in Batijer HH (eds): Cerebrovascular Disease. Philadelphia, Lippincott Raven, pp 1043–1053

    Google Scholar 

  25. Mehta B, Burke T, Kole M, Bydon A, Seyfried D, Malik G (2003) Stent-within-a-stent technique for the treatment of dissecting vertebral artery aneurysms. AJNR Am J Neuroradiol 24:1814–1818

    PubMed  Google Scholar 

  26. Murayama Y, Vinuela F, Duckwiler GR, Gobin YP, Guglielmi G (1999) Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90:207–214

    Article  PubMed  CAS  Google Scholar 

  27. Peerless SJ, Hemesniemi JA, Gutman FB, Drake CG (1994) Early surgery for ruptured vertebrobasilar aneurysms. J Neurosurg 80:643–649

    Article  PubMed  CAS  Google Scholar 

  28. Pelluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB (2008) Endovascular treatment of symptomatic intradural dissecting aneurysms. AJNR Am J Neuroradiol 29:102–106

    Article  Google Scholar 

  29. Ruecker M, Furtner M, Knoflach M, Werner P, Gotwald T, Chemelli A, Zangerle A, Prantl B, Matosevic B, Schmidauer C, Schmutzhard E, Willeit J, Kiechl S (2010) Basilar artery dissection: series of 12 consecutive cases and review of the literature. Cerebrovasc Dis 30:267–276

    Article  PubMed  CAS  Google Scholar 

  30. Sanders WP, Sorek PA, Mehra BA (1993) Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. AJNR Am J Neuroradiol 14:675–680

    PubMed  CAS  Google Scholar 

  31. Shin YS, Kim HS, Kim SY (2007) Stenting for vertebrobasilar dissection: a possible treatment option for nonhemorrhagic vertebrobasilar dissection. Neuroradiology 49:149–156

    Article  PubMed  Google Scholar 

  32. Suh SH, Kim BM, Park SI, Kim DI, Shin YS, Kim EJ, Chung EC, Koh JS, Shin HC, Choi CS, Won YS (2009) Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. J Neurosurg 111:48–52

    Article  PubMed  Google Scholar 

  33. Tasker AD, Byrne JV (1997) Basilar artery fenestration in association with aneurysms of the posterior cerebral circulation. Neuroradiology 39:185–189

    Article  PubMed  CAS  Google Scholar 

  34. Uda K, Murayama Y, Gobin YP, Duckwiler GR, Vinuela F (2001) Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: clinical experience with 41 aneurysms in 39 patients. J Neurosurg 95:624–632

    Article  PubMed  CAS  Google Scholar 

  35. van Rooij WJJ, Sluzewski M, Menovsky T, Wijnalda D (2003) Coiling of saccular basilar trunk aneurysms. Neuroradiology 45:19–21

    PubMed  Google Scholar 

  36. Wang Q, Leng B, Song D, Chen G (2010) Fusiform aneurysms of the vertebrobasilar arterial trunk: choice of endovascular methods and therapeutic efficacy. Acat Neurochir (Wien) 152:1467–1476

    Article  Google Scholar 

  37. Yang TK, Kim CJ, Ahn BJ (2001) Clipping of basilar trunk aneurysm. Case report. J Korean Neurosurg Soc (Supplement I) 30:S128–S132

    Google Scholar 

  38. Yoon SM, Chun YI, Kwon Y, Kwun BD (2004) Vertebrobasilar junction aneurysms associated with fenestration: experience of five cases treated with Guglielmi detachable coils. Surg Neurol 61:248–254

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by an INHA UNIVERSITY Research Grant.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Inha University School of Medicine, Incheon, Republic of Korea

    Joonho Chung, Hyeonseon Park & Dong-Keun Hyun

  2. Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea

    Yong Cheol Lim

  3. Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505, Banpo-Dong, Seocho-Gu, 137-701, Seoul, Republic of Korea

    Yong Sam Shin

Authors
  1. Joonho Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyeonseon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong Cheol Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dong-Keun Hyun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yong Sam Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Sam Shin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chung, J., Park, H., Lim, Y.C. et al. Endovascular treatment of basilar artery trunk aneurysms. Acta Neurochir 153, 2137–2145 (2011). https://doi.org/10.1007/s00701-011-1117-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-011-1117-z

Keywords

Search

Navigation