Basilar Artery Trunk Aneurysm: Spontaneous Subarachnoid Hemorrhage Due to an Aneurysm Associated with a Fenestration of the Basilar Artery, Endovascular Coil Occlusion
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The following case concerns a young female patient with spontaneous subarachnoid hemorrhage (SAH) due to a ruptured aneurysm originating at a non-fused, fenestrated proximal segment of the basilar artery. The aneurysm was treated with endovascular coil embolization which resulted in complete exclusion, and the patient showed a complete clinical recovery. A second aneurysm originating from the left internal carotid artery (ICA) was diagnosed during the follow-up and was treated in a separate session using a flow diverter stent. Three additional cases of ruptured aneurysms of non-fused basilar arteries are presented at the end of the discussion. Basilar artery fenestration with associated aneurysm formation is the main topic of this chapter.
KeywordsBasilar artery trunk Fenestration Subarachnoid hemorrhage Coiling pCONus
- Campos J, Fox AJ, Viñuela F, Lylyk P, Ferguson GG, Drake CG, Peerless SJ. Saccular aneurysms in basilar artery fenestration. AJNR Am J Neuroradiol. 1987;8(2):233–6.
- Finlay HM, Canham PB. The layered fabric of cerebral artery fenestrations. Stroke. 1994;25(9):1799–806.
- Fujimura M, Sugawara T, Higuchi H, Oku T, Seki H. A ruptured aneurysm at the distal end of the basilar artery fenestration associated with multiple fenestrations of the vertebrobasilar system: case report. Surg Neurol. 1997;47(5):469–72.
- Gregg L, Gailloud P. The role of the primitive lateral basilovertebral anastomosis of Padget in variations of the vertebrobasilar arterial system. Anat Rec (Hoboken). 2017;300(11):2025–38. .
- Miyazaki S, Kamata K, Yamaura A. Multiple aneurysms of the vertebrobasilar system associated with fenestration of the vertebral artery. Surg Neurol. 1981;15(3):192–5. .
- Nakstad PH, Bakke SJ, Dale LG, Moen G. Basilar artery fenestration aneurysms treated with guglielmi detachable coils. Interv Neuroradiol. 1998;4(1):75–80. .
- Padget DH. The development of the cranial arteries in the human embryo. Contrib Embryol. 1948;32:205–61.
- Picard L, Roy D, Bracard S, Per A, Marchal JC. Aneurysm associated with a fenestrated basilar artery: report of two cases treated by endovascular detachable balloon embolization. AJNR Am J Neuroradiol. 1993;14(3):591–4.
- Puchades-Orts A, Nombela-Gomez M, Ortuño-Pacheco G. Variation in form of circle of Willis: some anatomical and embryological considerations: some considerations on the circle of Willis. Anat Rec. 1976;185(1):119–23. .
- Sanders WP, Sorek PA, Mehta BA. Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. AJNR Am J Neuroradiol. 1993;14(3):675–80.
- Stark MM, Skeik N, Delgado Almandoz JE, Crandall BM, Tubman DE. Concurrent basilar artery double 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. .
- Tanaka M, Kikuchi Y, Ouchi T. Neuroradiological analysis of 23 cases of basilar artery fenestration based on 2280 cases of MR angiographies. Interv Neuroradiol. 2006;12(Suppl 1):39–44. .
- Tasker AD, Byrne JV. Basilar artery fenestration in association with aneurysms of the posterior cerebral circulation. Neuroradiology. 1997;39(3):185–9. .
- Tsuei YS, Matsumoto Y, Ohta M, Nakayama T, Ezura M, Takahashi A. Vertebrobasilar junction fenestration with dumbbell-shaped aneurysms formation: computational fluid dynamics analysis. Surg Neurol. 2009;72(Suppl 2):S11–9.
- Van Den Bergh R, Van Der Eecken H. Anatomy and embryology of cerebral circulation. Prog Brain Res. 1968;30:1–25. . Elsevier.
- Wollschlaeger G, Wollschlaeger PB, Lucas FV, Lopez VF. Experience and result with postmortem cerebral angiography performed as routine procedure of the autopsy. Am J Roentgenol Radium Therapy, Nucl Med. 1967;101(1):68–87.