Article Figures & Data
Figures
- Fig 1.
52-year-old woman with good-grade SAH. A and B, 3D angiogram (A) shows a small vertebrobasilar junction aneurysm on the proximal part of a basilar fenestration and 6 months (B) later demonstrates stable complete occlusion of the aneurysm.
- Fig 2.
A 64-year-old man with ruptured vertebrobasilar junction aneurysm. A and B, 3D (A) and 2D (B) angiograms demonstrate a dumbbell-shaped vertebrobasilar junction aneurysm on the bridging artery of a basilar fenestration. C, After coiling is performed, complete occlusion is seen.
- Fig 3.
A 29-year-old man with sudden neck pain followed by right-sided muscle weakness and difficulty in swallowing. A and B, MR image (A) and frontal bilateral vertebral angiogram (B) show a giant partially thrombosed vertebrobasilar junction aneurysm compressing the brain stem. C, Bilateral frontal carotid angiogram after occluding the right vertebral artery proximal to the PICA with a balloon (arrow) and the left vertebral artery distal to the PICA with coils (double arrow). Flow to the basilar artery is reversed with outflow to the right PICA, yet the aneurysm lumen still fills. D, Lateral radiograph during coiling of the aneurysm lumen via the posterior communicating artery 2 months later. The arrow indicates deflated balloon remnant in the right vertebral artery. The double arrow indicates coils in the left vertebral artery. E–G, Six months later, a frontal view of right carotid angiogram (E) demonstrates filling of the basilar artery via the right posterior communicating artery. Frontal view of the right thyrocervical trunk (F) shows recanalization of the distal right vertebral artery with filling of the PICA territory. Frontal view of the left vertebral angiogram (G) shows filling of the left PICA territory. The aneurysm is completely occluded. H, MR imaging 2 years after presentation shows remarkable shrinkage of the aneurysm. The patient was free of symptoms.
- Fig 4.
3D angiogram shows a vertebrobasilar junction aneurysm on the bridging artery of a basilar fenestration. With this anatomy, sparing the parent bridging artery would be sensible in preserving flow to the basilar artery. RV indicates right vertebral artery; LV, left vertebral artery; BA, basilar artery. (Compare with Fig 2.)
Tables
Patient and aneurysm characteristics of 10 patients with vertebrobasilar junction aneurysms
Patient No./Sex/ Age Clinical Presentation Aneurysm Timing Treatment Initial/Final Result (%) Outcome (months) Angiographic Follow-Up Remarks 1/F/75 SAH + IVH, HH V 10-mm, dumbbell, fenestration 2 days Coil occlusion 100 GOS 3 (43) Refused Dependent in nursing home 2/F/46 SAH, HH III 12 mm, fenestration 2 days Coil occlusion 90–90 GOS 1 (30) 30 months Additional AcomA aneurysm coiled 3/M/31 SAH, HH III 7 mm 10 days Coil occlusion 100–100 GOS 1 (18) 6 months – 4/F/52 SAH, HH II 5 mm, fenestration 2 days Coil occlusion 100–100 GOS 1 (24) 24 months – 5/F/44 SAH + IVH, HH IV 6 mm, fenestration 3 days Coil occlusion, EVD 100 GOS 5 (0.2) – Died of vasospasm 6/M/64 SAH + IVH, HH I 10 mm, dumbbell fenestration 2 days Coil occlusion, EVD 100–100 GOS 1 (27) 12 months Died 27 months later of cardiac disease 7/M/29 SAH + IVH, HH III 12-mm, dumbbell 2 days Coil occlusion 90–100 GOS 1 (6) 6 months Progressive thrombosis, aneurysm + V4 segments bilaterally 8/M/55 SAH + IVH, HH II 5 mm, fenestration 6 days Coil occlusion 100–90 GOS 1 (27) 27 months 9/F/70 SAH + IVH, HH V 17 mm, fenestration 1 day Coil occlusion EVD 100 GOS (0.1) – Died of SAH 10/M/30 Mass effect: neck pain, right sided muscle, weakness, and swallowing difficulty 47 mm, partially thrombosed – Bilateral vertebral artery occlusion, V3 right, V4 left, later coiling via PcomA 0–100 GOS 1 (24) 24 months Progressive complete thrombosis and partial involution aneurysm + V4 segments bilaterally; mass effect cured Note:—IVH indicates intraventricular hemorrhage; GOS, Glasgow Outcome Scale; –, not applicable; EVD, extraventricular drainage; PcomA, posterior communicating artery; AcomA, anterior communicating artery; SAH, subarachnoid hemorrhage; HH, Hunt and Hess scale.
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