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Basilar artery perforator aneurysms: a comparison with non-perforator saccular aneurysms

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Abstract

Background

Basilar artery perforator aneurysms (BAPAs) are rare. There is no systematic description of their presentation, imaging, natural history and outcomes and how these compare to conventional non-perforator aneurysms. Thus, the authors in this study aimed to compare BAPAs to non-perforator aneurysms.

Methods

Cases were identified from a prospective neurovascular database, notes and imaging retrospectively reviewed and compared to a consecutive series of patients with non-perforator aneurysms. Blood volume on CT and vessel wall imaging (VWI) were compared to controls.

Results

9/739 patients with aneurysmal subarachnoid haemorrhage (aSAH) harboured BAPAs. Compared to 103 with aSAH from posterior circulation aneurysms, they were more likely to be male (6/9, p = 0.008), but of equal severity (4/9 poor grade, p = 0.736) and need of CSF drainage (5/9, p = 0.154). Blood volume was similar to controls (30.2 ml vs 26.7 ml, p = 0.716). 6/9 BAPAs were initially missed on CTA. VWI showed thick (2.9 mm ± 2.7) bright enhancement (stalk ratio 1.05 ± 0.12), similar to controls with ruptured aneurysms (0.95 ± 0.23, p = 0.551), and greater than unruptured aneurysms (0.43 ± 0.11, p < 0.001). All were initially managed conservatively. Six thrombosed spontaneously. Three grew and had difficult access with few good endovascular options and were treated through a subtemporal craniotomy without complication. None rebled. At 3 months, all presenting in poor grade were mRS 3–4 and those in good grade mRS 1–2.

Conclusions

Despite their small size, BAPAs present with similar volume SAH, WFNS grade and hydrocephalus to other aneurysms. They are difficult to identify on CTA but enhance strikingly on VWI. The majority thrombosed. Initial conservative management reserving treatment for growth was associated with no rebleeds or complications.

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Data availability

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Code availability

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References

  1. Aboukais R, Zairi F, Estrade L, Quidet M, Leclerc X, Lejeune JP (2016) A dissecting aneurysm of a basilar perforating artery. Neurochirurgie 62(5):263–265. https://doi.org/10.1016/J.NEUCHI.2016.03.003

    Article  PubMed  CAS  Google Scholar 

  2. Apok V, Tarnaris A, Brydon HL (2013) An unusual aneurysm of a basilar perforating artery presenting with a subarachnoid haemorrhage. Br J Neurosurg 27(1):105–107. https://doi.org/10.3109/02688697.2012.717977

    Article  PubMed  Google Scholar 

  3. Bhogal P, AlMatter M, Hellstern V et al (2019) Basilar artery perforator aneurysms: report of 9 cases and review of the literature. J Clin Neurosci 63:122–129. https://doi.org/10.1016/J.JOCN.2019.01.026

    Article  PubMed  CAS  Google Scholar 

  4. Buell TJ, Ding D, Raper DMS, Chen CJ, Hixson HR, Crowley RW, Evans AJ, Jensen ME, Liu KC (2018) Posterior circulation perforator aneurysms: a proposed management algorithm. J Neurointervent Surg 10(1):55–59. https://doi.org/10.1136/neurintsurg-2016-012891

    Article  Google Scholar 

  5. Chalouhi N, Jabbour P, Starke RM et al (2014) Treatment of a basilar trunk perforator aneurysm with the pipeline embolization device: case report. Neurosurgery 74(6):E697–E701. https://doi.org/10.1227/NEU.0000000000000308

    Article  PubMed  Google Scholar 

  6. Chau Y, Sachet M, Sédat J (2018) Should we treat aneurysms in perforator arteries from the basilar trunk? Review of 49 cases published in the literature and presentation of three personal cases. Interv Neuroradiol 24(1):22–28. https://doi.org/10.1177/1591019917734531

    Article  PubMed  Google Scholar 

  7. Chavent A, Lefevre PH, Thouant P et al (2014) Spontaneous resolution of perforator aneurysms of the posterior circulation: report of 3 cases. J Neurosurg 121(5):1107–1111. https://doi.org/10.3171/2014.7.JNS132411

    Article  PubMed  Google Scholar 

  8. Chen L, Chen E, Chotai S, Tian X (2012) An endovascular approach to ruptured aneurysms of the circumferential branch of the basilar artery. J Clin Neurosci 19(4):527–531. https://doi.org/10.1016/J.JOCN.2011.04.049

    Article  PubMed  Google Scholar 

  9. Cox M, Song JW, Nabavizadeh SA, Kung D, Loevner L, Choudhri O (2021) Detection of angiographically occult ruptured basilar sidewall perforator aneurysm by vessel wall MR imaging. Neurohospitalist 11(2):156–159. https://doi.org/10.1177/1941874420963648

    Article  PubMed  Google Scholar 

  10. Daruwalla VJ, Syed FH, Elmokadem AH, Hurley MC, Shaibani A, Ansari SA (2016) Large basilar perforator pseudoaneurysm: a case report. Interv Neuroradiol 22(6):662–665. https://doi.org/10.1177/1591019916659261

    Article  PubMed  PubMed Central  Google Scholar 

  11. Deshaies EM, Jacobsen W, Krishnamurthy S, Deshaies EM, Jacobsen W, Krishnamurthy S (2011) Enterprise stent-within-stent embolization of a basilar artery perforator aneurysm. World J Neurosci 1(3):45–48. https://doi.org/10.4236/WJNS.2011.13007

    Article  Google Scholar 

  12. Ding D, Starke RM, Jensen ME, Evans AJ, Kassell NF, Liu KC (2013) Perforator aneurysms of the posterior circulation: case series and review of the literature. J Neurointerv Surg 5(6):546–551. https://doi.org/10.1136/neurintsurg-2012-010557

    Article  PubMed  Google Scholar 

  13. Elsheikh S, Möhlenbruch M, Seker F, Berlis A, Maurer C, Kocer N, Jamous A, Behme D, Taschner C, Urbach H, Meckel S (2022) Flow diverter treatment of ruptured basilar artery perforator aneurysms: a multicenter experience. Clin Neuroradiol 32(3):783–789. https://doi.org/10.1007/s00062-021-01133-y

    Article  PubMed  PubMed Central  Google Scholar 

  14. Finitsis S, Derelle AL, Tonnelet R, Anxionnat R, Bracard S (2017) Basilar Perforator aneurysms: presentation of 4 cases and review of the literature. World Neurosurg 97:366–373. https://doi.org/10.1016/J.WNEU.2016.10.038

    Article  PubMed  Google Scholar 

  15. Forbrig R, Eckert B, Ertl L et al (2016) Ruptured basilar artery perforator aneurysms–treatment regimen and long-term follow-up in eight cases. Neuroradiology 58(3):285–291. https://doi.org/10.1007/S00234-015-1634-1

    Article  PubMed  Google Scholar 

  16. Forbrig R, Eckert B, Ertl L et al (2016) Ruptured basilar artery perforator aneurysms—treatment regimen and long-term follow-up in eight cases. Neuroradiology 58(3):285–291. https://doi.org/10.1007/s00234-015-1634-1

    Article  PubMed  Google Scholar 

  17. Ghogawala Z, Shumacher JM, Ogilvy CS (1996) Distal basilar perforator artery aneurysm: case report. Neurosurgery 39(2):393–396. https://doi.org/10.1097/00006123-199608000-00034

    Article  PubMed  CAS  Google Scholar 

  18. Granja MF, Monteiro A, Agnoletto GJ et al (2020) A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish? J Neurointerv Surg 12(4):412–416. https://doi.org/10.1136/neurintsurg-2019-015311

    Article  PubMed  Google Scholar 

  19. Gross BA, Puri AS, Du R (2013) Basilar trunk perforator artery aneurysms. Case report and literature review. Neurosurg Rev 36(1):163–168. https://doi.org/10.1007/s10143-012-0422-1

    Article  PubMed  Google Scholar 

  20. Hamel W, Grzyska U, Westphal M, Kehler U (2005) Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir (Wien) 147(12):1283–1286. https://doi.org/10.1007/s00701-005-0615-2

    Article  PubMed  CAS  Google Scholar 

  21. Kassell NF, Torner JC (1983) Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13(5):479–481. https://doi.org/10.1227/00006123-198311000-00001

    Article  PubMed  CAS  Google Scholar 

  22. Mathieson CS, Barlow P, Jenkins S, Hanzely Z (2010) An unusual case of spontaneous subarachnoid haemorrhage a ruptured aneurysm of a basilar perforator artery. Br J Neurosurg 24(3):291–293. https://doi.org/10.3109/02688690903572095

    Article  PubMed  Google Scholar 

  23. Nyberg EMK, Imran Chaudry M, Turk AS, Spiotta AM, Fiorella D, Turner RD (2013) Report of two cases of a rare cause of subarachnoid hemorrhage including unusual presentation and an emerging and effective treatment option. J Neurointerv Surg 5(5):e30–e30. https://doi.org/10.1136/NEURINTSURG-2012-010387

    Article  PubMed  Google Scholar 

  24. Pace A, Mitchell S, Casselden E et al (2018) A subarachnoid haemorrhage-specific outcome tool. Brain 141(4):1111–1121. https://doi.org/10.1093/BRAIN/AWY003

    Article  PubMed  Google Scholar 

  25. Park SQ, Kwon OK, Kim SH, Oh CW, Han MH (2009) Pre-mesencephalic subarachnoid hemorrhage: rupture of tiny aneurysms of the basilar artery perforator. Acta Neurochir (Wien) 151(12):1639–1645. https://doi.org/10.1007/S00701-009-0416-0

    Article  PubMed  Google Scholar 

  26. Peschillo S, Caporlingua A, Cannizzaro D et al (2016) Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms. J Neurointerv Surg 8(2):190–196. https://doi.org/10.1136/NEURINTSURG-2014-011511

    Article  PubMed  Google Scholar 

  27. Roa JA, Zanaty M, Osorno-Cruz C et al (2020) Objective quantification of contrast enhancement of unruptured intracranial aneurysms: a high-resolution vessel wall imaging validation study. J Neurosurg 134(3):862. https://doi.org/10.3171/2019.12.JNS192746

    Article  PubMed  PubMed Central  Google Scholar 

  28. R Core Team (2022) R: A language and environment for statistical computing. R: Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org

  29. Sanchez-Mejia RO, Lawton MT (2007) Distal aneurysms of basilar perforating and circumferential arteries. Report of three cases. J Neurosurg 107(3):654–659. https://doi.org/10.3171/JNS-07/09/0654

    Article  PubMed  Google Scholar 

  30. Satti SR, Vance AZ, Fowler D, Farmah AV, Sivapatham T (2017) Basilar artery perforator aneurysms (BAPAs): review of the literature and classification. J Neurointerv Surg 9(7):669–673. https://doi.org/10.1136/NEURINTSURG-2016-012407

    Article  PubMed  Google Scholar 

  31. Shlobin NA, Cantrell DR, Ansari SA et al (2020) Conservative management and natural history of ruptured basilar perforator artery aneurysms: two cases and literature review. World Neurosurg 138:218–222. https://doi.org/10.1016/J.WNEU.2020.03.042

    Article  PubMed  Google Scholar 

  32. Sivakanthan S, Carlson AP, van Loveren H, Agazzi S (2015) Surgical clipping of a basilar perforator artery aneurysm: a case of avoiding perforator sacrifice. J Neurol Surg A Cent Eur Neurosurg 76(1):79–82. https://doi.org/10.1055/S-0033-1356488

    Article  PubMed  Google Scholar 

  33. Zolnourian AH, Franklin S, Galea I, Bulters DO (2020) Study protocol for SFX-01 after subarachnoid haemorrhage (SAS): a multicentre randomised double-blinded, placebo controlled trial. BMJ Open 10(3):e028514. https://doi.org/10.1136/BMJOPEN-2018-028514

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Figure 5C was created by Sketchymedic JM.

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Authors and Affiliations

  1. Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK

    Antony Kaldas, Ardalan Zolnourian, Frederick Ewbank, Ronneil Digpal & Diederik Bulters

  2. Department of Interventional Neuroradiology, University Hospital Southampton, Southampton, UK

    Ana Narata, Adam Ditchfield & Jason Macdonald

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  1. Antony Kaldas
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Contributions

Conceptualisation: D.B. and J.M.; data curation: A.K., F.E., A.Z., R.D., A.N., A.D. and J.M.; formal analysis: A.K., D.B. and R.D.; software: A.Z. and R.D.; supervision: D.B.; writing original draft: A.K. and D.B.; writing review and editing: A.K., A.Z., F.E., R.D., A.N., A.D., J.M. and D.B. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Diederik Bulters.

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Kaldas, A., Zolnourian, A., Ewbank, F. et al. Basilar artery perforator aneurysms: a comparison with non-perforator saccular aneurysms. Acta Neurochir 166, 141 (2024). https://doi.org/10.1007/s00701-024-06026-w

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