Skip to main content

Advertisement

SpringerLink
Log in

Combined endovascular and surgical treatment of fusiform aneurysms of the basilar artery: technical note

  • Technical Note - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

To present the combined treatment of fusiform basilar artery aneurysms consisting of a surgical posterior fossa decompressive craniectomy and ventriculoperitoneal (VP) shunt operation at the same sitting, before the endovascular procedure with telescopic stenting of the aneurysmatic vessel segment in four cases.

Methods

Combined treatment involving surgical procedure consisting of ventriculoperitoneal shunt placement for hydrocephalus and an occipital bone craniectomy and C1 vertebrae posterior laminectomy to decompress the posterior fossa in the same session. After surgery, the patients were loaded with acetylsalicylic acid and clopidogrel, and then the endovascular treatment was performed.

Results

All of the procedures were performed successfully without technical difficulty. The patients tolerated the procedures well and all cases showed remodelling with the overlapping stent technique. The patients were discharged home with baseline neurological situation and computed tomography (CT) angiography was performed at the 3rd month.

Conclusion

This technique is a safer endovascular approach to treating symptomatic fusiform basilar artery aneurysms by protecting patients from both the haemorrhagic complications of anticoagulant therapy and thrombotic complications due to the interruption of anticoagulant therapy, while treating the hydrocephalus and compression by surgical means.

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

References

  1. Abtin K, Thompson BG, Walker ML (1998) Basilar artery perforation as a complication of endoscopic third ventriculostomy. Pediatr Neurosurg 28(1):35–41

    Article  CAS  PubMed  Google Scholar 

  2. Amin-Hanjani S, Ogilvy CS, Buonanno FS, Choi IS, Metz LN (1997) Treatment of dissecting basilar artery aneurysm by flow reversal. Acta Neurochir (Wien) 139(1):44–51

    Article  CAS  Google Scholar 

  3. Anson JA, Lawton MT, Spetzler RF (1996) Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84(2):185–193

    Article  CAS  PubMed  Google Scholar 

  4. Bezerra S, Casaroto E, Bueno Alves MB, Goulart L, Annes M, Silva GS (2011) The challenge of managing fusiform basilar artery aneurysms: from acute ischemic stroke to a massive subarachnoid hemorrhage: case report. Neurology 3(1):50–53

    Google Scholar 

  5. Blanc R, Weill A, Piotin M, Ross IB, Moret J (2001) Delayed stroke secondary to increasing mass effect after endovascular treatment of a giant aneurysm by parent vessel occlusion. AJNR Am J Neuroradiol 22(10):1841–1843

    CAS  PubMed  Google Scholar 

  6. Chung J, Park H, Lim YC, Hyun DK, Shin YS (2011) Endovascular treatment of basilar artery trunk aneurysms. Acta Neurochir (Wien) 153(11):2137–2145

    Article  Google Scholar 

  7. Coert BA, Chang SD, Do HM, Marks MP, Steinberg GK (2007) Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms. J Neurosurg 106(5):855–865

    Article  PubMed  Google Scholar 

  8. Cohen JE, Gomori JM, Moscovici S, Itshayek E (2012) Successful endovascular treatment of a growing megadolichoectasic vertebrobasilar artery aneurysm by flow diversion using the “diverter-in-stent” technique: case report. J Clin Neurosci 19(1):166–170

    Article  PubMed  Google Scholar 

  9. Crowley RW, Evans AJ, Kassell NF, Jensen ME, Dumont AS (2009) Endovascular treatment of a fusiform basilar artery aneurysm using multiple “in-stent stents”: technical note. J Neurosurg Pediatr 3(6):496–500

    Article  PubMed  Google Scholar 

  10. Darsaut TE, Darsaut N, Chang SD, Silverberg GD, Shuer LM, Tian L, Dodd RL, Do HM, Marks MP, Steinberg GK (2011) Predictors of clinical and angiographic outcome after surgical or endovascular therapy of very large and giant ıntracranial aneurysms. Neurosurgery 68(4):903–915

    PubMed  Google Scholar 

  11. Drake CG, Peerless SJ (1997) Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87(2):141–162

    Article  CAS  PubMed  Google Scholar 

  12. Ferreira MA, Tedeschi H, Wen HT, Oliveira E (2000) Posterior circulation aneurysms: guideline to management. Oper Tech Neurosurg 3:169–178

    Article  Google Scholar 

  13. 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(2):291–300

    Article  PubMed  Google Scholar 

  14. Fiorella D, Kelly ME, Albuquerque FC, Nelson PK (2009) Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device. Neurosurgery 64(2):212–217

    Article  PubMed  Google Scholar 

  15. Fiorella D, Woo HH, Albuquerque FC, Nelson PK (2008) Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62(5):1115–1120

    Article  PubMed  Google Scholar 

  16. Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Huston J 3rd, McClelland RL, Christianson TJ (2005) The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovasc Dis 20(4):270–279

    Article  PubMed  Google Scholar 

  17. Gelal F, Vidinli BD, Yurt A, Cakir Y, Uygur M (2002) Giant fusiform basilar artery aneurysm causing obstructive hydrocephalus: case report. Skull Base 12(4):197–200

    Article  PubMed Central  PubMed  Google Scholar 

  18. 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(5):455–462

    Article  PubMed  Google Scholar 

  19. Higashida RT, Smith W, Gress D, Urwin R, Dowd CF, Balousek PA, Halbach VV (1997) Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87(6):944–949

    Article  CAS  PubMed  Google Scholar 

  20. Hoh BL, Kleinhenz DT, Chi YY, Mocco J, Barker FG 2nd (2011) Incidence of ventricular shunt placement for hydrocephalus with clipping versus coiling for ruptured and unruptured cerebral aneurysms in the nationwide inpatient sample database: 2002 to 2007. World Neurosurg 76(6):548–554

    Article  PubMed  Google Scholar 

  21. Hoh BL, Putman CM, Budzik RF, Carter BS, Ogilvy CS (2001) Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization. J Neurosurg 95(1):24–35

    Article  CAS  PubMed  Google Scholar 

  22. Horowitz M, Albright AL, Jungreis C, Levy EI, Stevenson K (2001) Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report. Neurosurgery 49(6):1461–1464

    Article  CAS  PubMed  Google Scholar 

  23. Iihara K, Murao K, Sakai N, Soeda A, Ishibashi-Ueda H, Yutani C, Yamada N, Nagata I (2003) Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum. Case report. J Neurosurg 98(2):407–413

    Article  PubMed  Google Scholar 

  24. Kasliwal MK, Agrawal D, Shanker Sharma B, Mishra NK (2007) Sudden cardiac arrest in a successfully embolized case of giant vertebral artery aneurysm with hydrocephalus. Surg Neurol 67(6):652–653

    Article  PubMed  Google Scholar 

  25. Kim MS, Oh CW, Han DH (2002) Growth of basilar artery aneurysm after ventriculo-peritoneal shunt. J Clin Neurosci 9(6):696–702

    Article  PubMed  Google Scholar 

  26. Kis B, Weber W, Götz F, Becker H, Berlit P, Kühne D (2007) Endovascular treatment of cerebral aneurysms using the Leo stent: long-term follow-up and expansion of ındications. Clin Neuroradiol 17:167–179

    Article  Google Scholar 

  27. Klisch J, Turk A, Turner R, Woo HH, Fiorella D (2011) Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms: original research. AJNR Am J Neuroradiol 32(4):627–632

    Article  CAS  PubMed  Google Scholar 

  28. Komotar RJ, Mocco J, Solomon RA (2008) Guidelines for the surgical treatment of unruptured intracranial aneurysms: the first annual J. Lawrence pool memorial research symposium–controversies in the management of cerebral aneurysms. Neurosurgery 62:183–193

    Article  PubMed  Google Scholar 

  29. Kourtopoulos H, Shamsgovara P, Dahlkvist A, Jonasson P (2005) Transclival decompression of brainstem from a compressing coiled aneurysm of the midbasilar artery. Acta Neurochir (Wien) 147(12):1291–1295

    Article  CAS  Google Scholar 

  30. Krings T, Alvarez H, Reinacher P, Ozanne A, Baccin CE, Gandolfo C, Zhao WY, Reinges MH, Lasjaunias P (2007) Growth and rupture mechanism of partially thrombosed aneurysms. Interv Neuroradiol 13(2):117–126

    CAS  PubMed Central  PubMed  Google Scholar 

  31. Kulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ, Renowden S, Gál G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rüfenacht DA (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32(1):20–25

    PubMed  Google Scholar 

  32. Kung DK, Policeni BA, Capuano AW, Rossen JD, Jabbour PM, Torner JC, Howard MA, Hasan D (2011) Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg 114(4):1021–1027

    Article  PubMed  Google Scholar 

  33. Kwan ESK, Heilman CB, Shucart WA, Klucznik RP (1991) Enlargement of basilar artew aneurysms following balloon occlusion “water-hammer effect”. J Neurosurg 75(6):963–968

    Article  CAS  PubMed  Google Scholar 

  34. Lawton MT, Daspit CP, Spetzler RF (1997) Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41(3):513–520

    CAS  PubMed  Google Scholar 

  35. 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(4):632–643

    Article  PubMed  Google Scholar 

  36. Nagahiro S, Takada A, Goto S, Kai Y, Ushio Y (1995) Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg 82(5):796–801

    Article  CAS  PubMed  Google Scholar 

  37. Obaid S, Weil AG, Bojanowski MW (2012) Endoscopic third ventriculostomy in the presence of large or giant basilar artery aneurysms. Acta Neurochir (Wien) 154(10):1845–1850

    Article  Google Scholar 

  38. Oertel JM, Mondorf Y, Gaab MR (2009) Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm. J Neurosurg 110:14–18

    Article  PubMed  Google Scholar 

  39. Oishi H, Shimizu T, Nakai K, Miyajima M, Arai H (2008) Successful treatment of a thrombosed posterior cerebral artery aneurysm causing obstructive hydrocephalus. J Clin Neurosci 15(2):199–202

    Article  PubMed  Google Scholar 

  40. Passero S, Filosomi G (1998) Posterior circulation infarcts in patients with vertebrobasilar dolichoectasia. Stroke 29(3):653–659

    Article  CAS  PubMed  Google Scholar 

  41. Pereira-Filho A, Faria M, Bleil C, Kraemer JL (2008) Brainstem compression syndrome caused by vertebrobasilar dolichoectasia: microvascular repositioning technique. Arq Neuropsiquiatr 66(2B):408–411

    Article  PubMed  Google Scholar 

  42. Pumar JM, Garcia-Dorrego R, Nieto A, Vazquez-Herrero F, Blanco-Ulla M, Vazquez- Martin A (2010) Vascular reconstruction of a fusiform basilar aneurysm with the Silk embolization system. J Neurointerv Surg 2(3):242–244

    Article  CAS  PubMed  Google Scholar 

  43. Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM (2003) Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24(7):1421–1428

    PubMed  Google Scholar 

  44. Raphaeli G, Collignon L, De Witte O, Lubicz B (2011) Endovascular treatment of posterior circulation fusiform aneurysms: single-center experience in 31 patients. Neurosurgery 69(2):274–283

    Article  PubMed  Google Scholar 

  45. Rezende MT, Spelle L, Piotin M, Mounayer C, Lucas Cde P, Abud DG, Moret J (2008) Selective endovascular treatment of a traumatic basilar aneurysm after endoscopic third ventriculostomy. Neuroradiology 50(5):443–446

    Article  PubMed  Google Scholar 

  46. Rickert CH, Grabellus F, Varchmin-Schultheiss K, Stöss H, Paulus W (2001) Sudden unexpected death in young adults with chronic hydrocephalus. Int J Legal Med 114(6):331–337

    Article  CAS  PubMed  Google Scholar 

  47. Ross IB, Dhillon GS (2003) Ventriculostomy-related cerebral hemorrhages after endovascular aneurysm treatment. AJNR Am J Neuroradiol 24(8):1528–1531

    PubMed  Google Scholar 

  48. Sato M, Nakai Y, Takigawa T, Takano S, Matsumura A (2012) Endoscopic third ventriculostomy for obstructive hydrocephalus caused by a large upper basilar artery aneurysm after coil embolization. Neurol Med Chir (Tokyo) 52(11):832–834

    Article  Google Scholar 

  49. Shi X, Qian H, Singh KC, Zhang Y, Zhou Z, Sun Y, Liu F (2013) Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients. Acta Neurochir (Wien) 155(6):1087–1093

    Article  Google Scholar 

  50. Stachura K, Libionka W, Moskała M (2008) Neuroendoscopic third ventriculostomy in the management of noncommunicating hydrocephalus secondary to giant basilar artery bifurcation aneurysm—case report and review of literature. Neurol Neurochir Pol 42(3):255–262

    PubMed  Google Scholar 

  51. Steel JG, Thomas HA, Strollo PJ (1982) Fusiform basilar aneurysm as a cause of embolic stroke. Stroke 13(5):712–716

    Article  CAS  PubMed  Google Scholar 

  52. Steinberg GK, Drake CG, Peerless SJ (1993) Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg 79(2):161–173

    Article  CAS  PubMed  Google Scholar 

  53. Tomokiyo M, Kazekawa K, Onizuka M, Aikawa H, Tsutsumi M, Ikoh M, Kodama T, Nii K, Matsubara S, Tanaka A (2007) Mechanisms of perianeurysmal edema following endovascular embolization of aneurysms. Interv Neuroradiol 13(1):145–150

    PubMed Central  PubMed  Google Scholar 

  54. Ubogu EE, Chase CM, Verrees MA, Metzger AK, Zaidat OO (2002) Cervicomedullary junction compression caused by vertebral artery dolichoectasia and requiringsurgical treatment: case report. J Neurosurg 96(1):140–143

    Article  PubMed  Google Scholar 

  55. Wakhloo AK, Mandell J, Gounis MJ, Brooks C, Linfante I, Winer J, Weaver JP (2008) Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: long-term clinical and angiographic follow-up. Stroke 39(12):3288–3296

    Article  PubMed  Google Scholar 

  56. Wang Q, Leng B, Song D, Chen G (2010) Fusiform aneurysms of the vertebrobasilar arterial trunk: choice of endovascular methods and therapeutic efficacy. Acta Neurochir (Wien) 152(9):1467–1476

    Article  Google Scholar 

  57. Yoon WK, Kim YW, Kim SR, Park IS, Kim SD, Jo KW, Baik MW (2010) Angiographic and clinical outcomes of stent-alone treatment for spontaneous vertebrobasilar dissecting aneurysm. Acta Neurochir (Wien) 152(9):1477–1486

    Article  Google Scholar 

  58. Zenteno MA, Santos-Franco JA, Freitas-Modenesi JM, Gómez C, Murillo-Bonilla L, Aburto-Murrieta Y, Díaz-Romero R, Nathal E, Gómez-Llata S, Lee A (2008) Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients. J Neurosurg 108(6):1104–1118

    Article  PubMed  Google Scholar 

  59. Zhang J, Zhang R, Wu Z, Lv X, Liu B (2010) Results of endovascular management for mid-basilar artery aneurysms. Interv Neuroradiol 16(3):249–254

    CAS  PubMed Central  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Kocamustafapasa-Istanbul, Turkey, 34098

    Osman Kizilkilic, Yasemin Kayadibi, Naci Koçer & Civan Islak

  2. Department of Neurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Kocamustafapasa-Istanbul, Turkey, 34098

    Galip Zihni Sanus

Authors
  1. Osman Kizilkilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasemin Kayadibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Galip Zihni Sanus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naci Koçer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Civan Islak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osman Kizilkilic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kizilkilic, O., Kayadibi, Y., Sanus, G.Z. et al. Combined endovascular and surgical treatment of fusiform aneurysms of the basilar artery: technical note. Acta Neurochir 156, 53–61 (2014). https://doi.org/10.1007/s00701-013-1913-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1913-8

Keywords

Search

Navigation