Treatment of fenestrated vertebrobasilar junction ruptured giant aneurysm associated with two inlets and two outlets: A case report

Yu-Chun Lu, Kha-Liang Lee, Shun-Tai Yang, Yueh-Hsun Lu, I-Chang Su

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Background: Basilar fenestration, as a result of the failed fusion of the paired fetal longitudinal neural arteries, is the most common intracranial arterial fenestration.
When a vertebra-basilar junction (VBJ) aneurysm is observed, the presence of an associated basilar fenestration should be suspected. Due to the fact that the anatomy of VBJ aneurysms associated with basilar fenestration is commonly complex, a precise analysis of the morphology is mandatory to a successful treatment strategy.
Case Presentation: A 63-year-old woman had acute consciousness disturbance with Glasgow Coma Scale of 6 (E1V1M4). Computed tomography (CT) and CT
angiography revealed a diffuse subarachnoid hemorrhage secondary to a ruptured giant aneurysm (maximal dome size: 26mm) at VBJ. Three-dimensional rotational catheter angiography with volume rendering further demonstrated the unusual morphology of the aneurysm, which extended from bilateral distal vertebral arteries (VA) to two limbs of an unfused lower basilar artery (BA) segment. Notably, each limbs of the unfused BA segment gave rise to an anterior- inferior cerebellar artery.
The aneurysm was successfully managed by stent-assisted coiling.
Conclusion: The strategy preserved the whole vertebro-basilar artery and therefore cerebellar arteries. The patient made complete recovery without neurologic sequelae.
Original languageUndefined/Unknown
JournalCase Reports and Images in Surgery
Publication statusPublished - Apr 2021

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