Flow diversion and microvascular plug occlusion for the treatment of a complex unruptured basilar/superior cerebellar artery aneurysm: case report

J Neurosurg. 2018 Jun 1:1-6. doi: 10.3171/2018.1.JNS172465. Online ahead of print.

Abstract

The authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. A 2-staged (combined deconstructive/reconstructive) procedure was successfully performed: first occluding the left SCA with a Pipeline embolization device (PED) coupled to a microvascular plug (MVP) in the absence of antiplatelet coverage, followed by reconstruction of the BAT by deploying a second PED from the right SCA into the basilar trunk. Six-month follow-up angiography confirmed uneventful aneurysm occlusion. The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.

Keywords: AICA = anterior inferior cerebellar artery; BA = basilar artery; BAT = basilar artery terminus; ICA = internal carotid artery; MPED = minimally porous endoluminal device; MVP = microvascular plug; PCA = posterior cerebral artery; PCoA = posterior communicating artery; PED = Pipeline embolization device; PICA = posterior inferior cerebellar artery; SCA = superior cerebellar artery; VA = vertebral artery; complex basilar artery terminus aneurysm; flow diverter; microvascular plug occlusion; vascular disorders.

Publication types

  • Case Reports