Treatment of dissecting basilar artery aneurysm by flow reversal.
Dissecting aneurysm of the basilar artery is a rare but increasingly recognized entity, with a frequently fatal or morbid outcome. Unlike the well established proximal occlusion and trapping approaches to vertebral artery dissections, surgical intervention for basilar lesions has been limited to wrapping techniques for arterial wall reinforcement. We report a case of midbasilar dissecting aneurysm successfully treated by clipping the proximal basilar artery below the level of the anterior inferior cerebellar arteries, allowing retrograde flow via the posterior communicating arteries to provide continued basilar perfusion. With the growing recognition of basilar dissection and pseudoaneurysm formation there is a need for improved therapeutic options. We suggest that definitive treatment can be achieved using the principle of proximal occlusion and flow reversal, and review the pertinent literature on basilar artery dissection.
Amin-Hanjani
S
S
Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Ogilvy
C S
CS
Buonanno
F S
FS
Choi
I S
IS
Metz
L N
LN
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D001921:Brain / Q000098:blood supply*; D002531:Cerebellum / Q000098:blood supply; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D012039:Regional Blood Flow; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*