This study reports our experience with the endovascular treatment of basilar artery (BA) trunk and branch aneurysms. Subjects included 16 patients with BA trunk and branch aneurysms who underwent endovascular treatment in our hospital from October 2000 to October 2009, including four patients with associated arteriovenous malformation (AVM), two with associated moyamoya disease, one with multiple aneurysms at adjacent sites, and one with a distant aneurysm. Endovascular coil embolization, together with stent or balloon assistance when necessary, or while occluding the parent artery was performed. Associated diseases were managed intraoperatively or in the second stage, or treated with gamma knife radiotherapy, or followed up. Two patients with unsuccessful embolization died of re-rupture at the fourth month and fifth month follow-up. The remaining 14 patients reported good outcomes and experienced no re-rupture of either the aneurysm or associated disease. Angiographic follow-ups were conducted for the 14 patients for six to 12 months. Digital subtraction angiography (DSA) examination at the last follow-up showed no recurrence of the BA trunk and branch aneurysms. Together, BA trunk and branch aneurysms should be actively managed via endovascular techniques to prevent serious consequences due to aneurysm rupture and bleeding. Favorable outcomes can be obtained by the proper selection of endovascular treatment regimens.
PeerlessSJHernesniemiJAGutmanFB. Early surgery for ruptured vertebrobasilar aneurysms. J Neurosurg. 1994; 80: 643–649.
2.
RiceBJPeerlessSJDrakeCG. Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg. 1990; 73: 165–173.
3.
HernesniemiJKaratasAIshiiK. Anteroinferior cerebellar artery aneurysms: Surgical approaches and outcomes—a review of 34 cases. Neurosurgery. 2005; 57: E601.
4.
MizoiKYoshimotoTTakahashiA. Direct clipping of basilar trunk aneurysms using temporary balloon occlusion. J Neurosurg. 1994; 80: 230–236.
5.
SeifertVStolkeD. Posterior transpetrosal approach to aneurysms of the basilar trunk and vertebrobasilar junction. J Neurosurg. 1996; 85: 373–379.
6.
SekharLNKaliaKKYonasH. Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery. 1994; 35: 472–481.
7.
GuglielmiGViñuelaFSepetkaI. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg. 1991; 75: 1–7.
8.
GuglielmiGViñuelaFDionJ. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg. 1991; 75: 8–14.
9.
StrotherCM. Historical perspective. Electrothrombosis of saccular aneurysms via endovascular approach: Part 1 and part 2. Am J Neuroradiol. 2001; 22: 1010–1012.
HallacqPPiotinMMoretJ. Endovascular occlusion of the posterior cerebral artery for the treatment of p2 segment aneurysms: Retrospective review of a 10-year series. Am J Neuroradiol. 2002; 23: 1128–1136.
12.
LubiczBBandeiraABruneauM. Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms. Neuroradiology. 2009; 51: 419–425.
13.
KlimoPJrKestleJRMacDonaldJD. Marked reduction of cerebral vasospasm with lumbar drainage of cerebrospinal fluid after subarachnoid hemorrhage. J Neurosurg. 2004; 100: 215–224.
14.
UdaKMurayamaYGobinYP. Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: Clinical experience with 41 aneurysms in 39 patients. J Neurosurg. 2001; 95: 624–632.
15.
RedekopGJDurityFAWoodhurstWB. Management-related morbidity in unselected aneurysms of the upper basilar artery. J Neurosurg. 1997; 87: 836–842.
16.
SugitaKKobayashiSTakemaeT. Aneurysms of the basilar trunk. J Neurosurg. 1987; 66: 500–505.
17.
LiuLJiangCHeH. Delayed thrombosis of the basilar artery after stenting for a basilar trunk dissection aneurysm. A case report and review of the literature. Interventional Neuroradiology2010; 16: 77–82.
18.
CrowleyRWEvansAJKassellNF. Endovascular treatment of a fusiform basilar artery aneurysm using multiple “in-stent stents”. Technical note. J Neurosurg Pediatr. 2009; 3(6): 496–500.
19.
KimBMSuhSHParkSI. Management and clinical outcome of acute basilar artery dissection. Am J Neuroradiol. 2008; 29: 1937–1941.
20.
Sanchez-MejiaROLawtonMT. Distal aneurysms of basilar perforating and circumferential arteries. Report of three cases. J Neurosurg. 2007; 107: 654–659.
PerataHJTomsickTATewJMJr. Feeding artery pedicle aneurysms: Association with parenchymal hemorrhage and arteriovenous malformation in the brain. J Neurosurg. 1994; 80: 631–634.
23.
LasjauniasPPiskeRTerbruggeK. Cerebral arteriovenous malformations (C. AVM) and associated arterial aneurysms (AA). Analysis of 101 C. AVM cases, with 37 AA in 23 patients. Acta Neurochir (Wien). 1988; 91 (1–2): 29–36.
24.
KawaguchiSSakakiTMorimotoT. Characteristics of intracranial aneurysms associated with moyamoya disease. A review of 111 cases. Acta Neurochir (Wien). 1996; 138: 1287–1294.
25.
SeifertV. Direct surgery of basilar trunk and vertebrobasilarjunction aneurysms via the combined transpetrosal approach. Neurol Med Chir.1998; 38 (Suppl): 86–92.
26.
AzizKMvan LoverenHRTewJMJr. The Kawase approach to retrosellar and upper clival basilar aneurysms. Neurosurgery. 1999; 44: 1225–1234.
27.
Van RooijWJSluzewskiMMenovskyT. Coiling of saccular basilar trunk aneurysms. Neuroradiology. 2003; 45: 19–21.
28.
MolyneuxAJKerrRSYuLM. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005; 366: 809–817.
29.
XavierJVasconcelosCCruzR. Endovascular treatment of dissecting aneurysms of the posterior cerebral artery. Acta Med Port.2001; 14: 65–70.
30.
KaiYHamadaJMoriokaM. Successful treatment of a ruptured dissecting basilar artery aneurysm. Case report. J Neurosurg. 2004; 100: 1072–1075.
31.
ChaloupkaJCPutmanCMAwadIA. Endovascular therapeutic approach to peripheral aneurysms of the superior cerebellar artery. Am J Neuroradiol. 1996; 17: 1338–1342.
32.
Amin-HanjaniSOgilvyCSBuonannoFS. Treatment of dissecting basilar artery aneurysm by flow reversal. Acta Neurochir (Wien). 1997; 139: 44–51.
33.
NakaharaTSatohHMizoueT. Dissecting aneurysm of basilar artery presenting with recurrent subarachnoid hemorrhage. Neurosurg Rev.1999; 22: 155–158.
RamgrenBCronqvistMRomnerB. Vertebrobasilar dissection with subarachnoid hemorrhage: A retrospective study of 29 patients. Neuroradiology. 2005; 47: 97–104.
37.
KimBMSuhSHParkSI. Management and clinical outcome of acute basilar artery dissection. Am J Neuroradiol. 2008; 29: 1937–1941.
38.
MassoudTFGuglielmiGViñuelaF. Saccular aneurysms in moyamoya disease: Endovascular treatment using electrically detachable coils. Surg Neurol. 1994; 41: 462–467.
39.
RedekopGJDurityFAWoodhurstWB. Management-related morbidity in unselected aneurysms of the upper basilar artery. J Neurosurg. 1997; 87: 836–842.
