Basilar Trunk Aneurysm: Blunt Head Trauma, Dissecting Aneurysm of the Proximal Basilar Trunk Causing a Subarachnoid Hemorrhage, Reconstruction of the Basilar Artery with Three Telescoping Flow Diverters Anchored in the Left Vertebral Artery, Followed by Coil Occlusion of the Right V4 Segment
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A 5-year-old girl suffered a head injury following a fall and presented with an acute headache, sixth nerve palsy, and a subarachnoid hemorrhage (SAH), graded as Hunt and Hess III, Fisher IV. A traumatic dissecting aneurysm of the proximal basilar trunk was treated by the endovascular implantation of three flow diverters which were deployed telescopically from the distal basilar artery into the left V4 segment, together with the coil occlusion of the right distal V4 segment to prevent an endoleak from this side. The postprocedural course was uneventful and the cranial nerve palsy resolved completely. Angiographic and MRI/MRA follow-up examinations after six months confirmed the almost complete occlusion of the aneurysm with only residual inflow of contrast medium at the origin of perforating basilar arteries. Prior to the availability of flow diverting stents, the treatment of dissecting intracranial artery aneurysms had been challenging. Flow diversion is technically easier than stent-assisted coil occlusion or stent grafting, especially in the case of a fusiform dissecting aneurysm. Placing a flow diverter into a dissected artery reconstructs the lacerated vessel segment itself. The main topics of this report are the treatment of dissected vessel segments with flow diversion in an acute situation and in the pediatric population.
KeywordsBasilar trunk Dissecting aneurysm Flow diversion p64 Pipeline Embolization Device (PED) Pediatric SAH
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