Advertisement

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

  • Christina M. Wendl
  • Marta Aguilar Pérez
  • Gerhard Schuierer
  • Hans Henkes
Living reference work entry

Abstract

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.

Keywords

Basilar trunk Dissecting aneurysm Flow diversion p64 Pipeline Embolization Device (PED) Pediatric SAH 

Notes

References

  1. Bhogal P, Brouwer PA, Söderqvist ÅK, Ohlsson M, Andersson T, Holmin S, Söderman M. Patients with subarachnoid haemorrhage from vertebrobasilar dissection: treatment with stent-in-stent technique. Neuroradiology. 2015;57(6):605–14.  https://doi.org/10.1007/s00234-015-1505-9.CrossRefPubMedGoogle Scholar
  2. Bhogal P, Pérez MA, Ganslandt O, Bäzner H, Henkes H, Fischer S. Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-center experience and review of 56 patients. J Neurointerv Surg. 2017;9(5):471–81.  https://doi.org/10.1136/neurintsurg-2016-012781.CrossRefPubMedGoogle Scholar
  3. Cerejo R, Bain M, Moore N, Hardman J, Bauer A, Hussain MS, Masaryk T, Rasmussen P, Toth G. Flow diverter treatment of intracranial vertebral artery dissecting pseudoaneurysms. J Neurointerv Surg. 2017;9(11):1064–8.  https://doi.org/10.1136/neurintsurg-2017-013020.CrossRefPubMedGoogle Scholar
  4. Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bäzner H, Henkes H. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012;54(4):369–82.  https://doi.org/10.1007/s00234-011-0948-x.CrossRefPubMedGoogle Scholar
  5. Krings T, Geibprasert S, terBrugge KG. Pathomechanisms and treatment of pediatric aneurysms. Childs Nerv Syst. 2010;26(10):1309–18.  https://doi.org/10.1007/s00381-009-1054-9.CrossRefPubMedGoogle Scholar
  6. Kühn AL, Kan P, Massari F, Lozano JD, Hou SY, Howk M, Gounis MJ, Wakhloo AK, Puri AS. Endovascular reconstruction of unruptured intradural vertebral artery dissecting aneurysms with the pipeline embolization device. J Neurointerv Surg. 2016;8(10):1048–51.  https://doi.org/10.1136/neurintsurg-2015-012028.CrossRefPubMedGoogle Scholar
  7. Lee CJ, Lee KW, Chen WL, Chiu CC. Images diagnosis and emergent endovascular treatment of acute hemorrhagic basilar artery dissection: a case report. Acta Neurol Taiwanica. 2016;25(2):45–50.Google Scholar
  8. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T. Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery. 1995;36(5):905–11; discussion 912-3CrossRefPubMedGoogle Scholar
  9. Nakatomi H, Nagata K, Kawamoto S, Furusho JI. Basilar artery occlusion due to spontaneous basilar artery dissection in a child. Acta Neurochir. 1999;141(1): 99–104.CrossRefPubMedGoogle Scholar
  10. Prasad V, Gandhi D, Jindal G. Pipeline endovascular reconstruction of traumatic dissecting aneurysms of the intracranial internal carotid artery. J Neurointerv Surg. 2014;6(10):e48.  https://doi.org/10.1136/neurintsurg-2013-010899.rep.CrossRefPubMedGoogle Scholar
  11. Saliou G, Power S, Krings T. Flow diverter placement for management of dissecting ruptured aneurysm in a non-fused basilar artery. Interv Neuroradiol. 2016;22(1):58–61.  https://doi.org/10.1177/1591019915617324.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Scazzeri F, Mascalchi M, Calabrese R, Quilici N. Case report. MRI and MR angiography of basilar artery dissection in a child. Neuroradiology. 1997;39(9): 654–7.CrossRefPubMedGoogle Scholar
  13. van Oel LI, van Rooij WJ, Sluzewski M, Beute GN, Lohle PN, Peluso JP. Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils. AJNR Am J Neuroradiol. 2013;34(3):589–95.  https://doi.org/10.3174/ajnr.A3255.CrossRefPubMedGoogle Scholar
  14. Yoshimoto Y, Hoya K, Tanaka Y, Uchida T. Basilar artery dissection. J Neurosurg. 2005;102(3):476–81.CrossRefPubMedGoogle Scholar
  15. Zarzecka A, Gory B, Turjman F. Implantation of two flow diverter devices in a child with a giant, fusiform vertebral artery aneurysm: case report. Pediatr Neurol. 2014;50(2):185–7.  https://doi.org/10.1016/j.pediatrneurol.2013.09.014.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Christina M. Wendl
    • 1
  • Marta Aguilar Pérez
    • 2
  • Gerhard Schuierer
    • 1
  • Hans Henkes
    • 2
  1. 1.Zentrum für NeuroradiologieUniversitätsklinikum und Bezirksklinikum RegensburgRegensburgGermany
  2. 2.Neuroradiologische KlinikNeurozentrum, Klinikum StuttgartStuttgartGermany

Personalised recommendations