Aneurysms of the Vertebrobasilar Junction: Incidence, Clinical Presentation, and Outcome of Endovascular Treatment

BACKGROUND AND PURPOSE: The aim of this retrospective study was to report the incidence, clinical presentation, and midterm clinical and imaging results of endovascular treatment of 10 aneurysms of the vertebrobasilar junction. MATERIALS AND METHODS: Between January 1995 and January 2007, 2112 aneurysms were treated in our institution. Ten aneurysms in 10 patients were located on the vertebrobasilar junction and 7 aneurysms (70%) were associated with proximal basilar fenestration. There were 5 men and 5 women, ranging from 29 to 75 years of age. Nine aneurysms presented with subarachnoid hemorrhage, and one was a giant partially thrombosed aneurysm with mass effect on the brain stem. RESULTS: Nine ruptured aneurysms were treated by primary coil occlusion. One giant unruptured aneurysm was initially treated with bilateral vertebral artery occlusion, 2 months later followed by selective coil occlusion of the remaining aneurysm lumen via the posterior communicating artery. At imaging follow-up of 6–30 months in 7 patients, all aneurysms were adequately occluded. In 2 patients, the vertebrobasilar junction and distal vertebral arteries (including the aneurysm) thrombosed completely on follow-up without clinical sequelae. CONCLUSION: Vertebrobasilar junction aneurysms are rare, with an incidence of 0.5% of treated aneurysms at our institution. Vertebrobasilar junction aneurysms are frequently associated with proximal basilar fenestration. Most patients present with subarachnoid hemorrhage. Endovascular treatment is effective and safe in excluding the aneurysms from the circulation.

[1]  F Viñuela,et al.  Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. , 1992, Journal of neurosurgery.

[2]  V. Seifert.  Direct surgery of basilar trunk and vertebrobasilar junction aneurysms via the combined transpetrosal approach. , 1998, Neurologia medico-chirurgica.

[3]  P. B. Wollschlaeger,et al.  Experience and result with postmortem cerebral angiography performed as routine procedure of the autopsy. , 1967, The American journal of roentgenology, radium therapy, and nuclear medicine.

[4]  Seok-Mann Yoon,et al.  Vertebrobasilar junction aneurysms associated with fenestration: experience of five cases treated with Guglielmi detachable coils. , 2004, Surgical neurology.

[5]  T. Kawase,et al.  Surgical approaches for vertebro-basilar trunk aneurysms located in the midline , 2005, Acta Neurochirurgica.

[6]  C. Strother,et al.  Vertebrobasilar junction aneurysms associated with fenestration: treatment with Guglielmi detachable coils. , 1996, AJNR. American journal of neuroradiology.

[7]  A. Fox,et al.  Saccular aneurysms in basilar artery fenestration. , 1987, AJNR. American journal of neuroradiology.

[8]  M. Kowada,et al.  Fenestration of the basilar artery. Report of three cases and review of the literature. , 1973, Radiology.

[9]  L. Ansbacher,et al.  Saccular aneurysm associated with segmental duplication of the basilar artery. A morphological study. , 1984, Journal of neurosurgery.

[10]  R. Giuffrè,et al.  The vertebral artery: developmental pathology. , 1999, Journal of neurosurgical sciences.

[11]  D. H. Padget,et al.  The development of the cranial arteries in the human embryo. , 1948 .

[12]  P. Versari,et al.  Aneurysms of the vertebro-basilar junction area: Preliminary experience in endovascular and surgical management , 2007, Acta Neurochirurgica.

[13]  V. Seifert,et al.  Management-Related Morbidity and Mortality in Unselected Aneurysms of the Basilar Trunk and Vertebrobasilar Junction , 2001, Acta Neurochirurgica.

[14]  A. Gruber,et al.  Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils: a 6-year experience. , 1999, Journal of neurosurgery.

[15]  V. Seifert,et al.  Posterior transpetrosal approach to aneurysms of the basilar trunk and vertebrobasilar junction. , 1996, Journal of neurosurgery.

[16]  D. Nichols,et al.  Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. , 1997, Journal of neurosurgery.

[17]  F. Nakagawa,et al.  Endovascular treatment of basilar trunk aneurysm associated with fenestration of the basilar artery , 1999, Neurosurgical Review.

[18]  A. Yamaura,et al.  Multiple aneurysms of the vertebrobasilar system associated with fenestration of the vertebral artery. , 1981, Surgical neurology.

[19]  L. Hopkins,et al.  Microvascular surgical anatomy of the vertebrobasilar junction. , 1997, Neurosurgery.

[20]  G. Duckwiler,et al.  Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: clinical experience with 41 aneurysms in 39 patients. , 2001, Journal of neurosurgery.

[21]  P. Canham,et al.  The Layered Fabric of Cerebral Artery Fenestrations , 1994, Stroke.

[22]  C. Tulleken,et al.  Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms , 2001, Neuroradiology.

[23]  B. Mehta,et al.  Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. , 1993, AJNR. American journal of neuroradiology.

[24]  K. Kazekawa,et al.  A vertebrobasilar junction aneurysm associated with fenestration treated by intra-aneurysmal embolization , 2003, Acta Neurochirurgica.

[25]  S. Kobayashi,et al.  Aneurysms of the basilar artery trunk. , 1987, Journal of neurosurgery.

[26]  L. Pierot,et al.  Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. , 1996, Neurosurgery.

[27]  I. Saatci,et al.  Endovascular treatment of kissing aneurysms at the fenestrated basilar artery. Case report with literature review. , 2002, Surgical neurology.

[28]  D. Roy,et al.  Aneurysm associated with a fenestrated basilar artery: report of two cases treated by endovascular detachable balloon embolization. , 1993, AJNR. American journal of neuroradiology.

[29]  H. Nakajima,et al.  Treatment of a Saccular Aneurysm at the Fenestration of the Intracranial Vertebral Artery with Guglielmi Detachable Coils , 1999, Acta Neurochirurgica.