title: A combined surgical and endovascular treatment for a case with five vertebro-basilar aneurysms and bilateral internal carotid artery occlusions.
abstract: BACKGROUND
  Whereas multiple aneurysms may be found in 20% of patients in whom one aneurysm is discovered, the identification of five vertebrobasilar aneurysms is distinctly rare. We described such a case treated by surgical and endovascular method.
  
  
  METHODS
  A case of multiple aneurysms treated with combined surgical clipping and intravascular surgery is described. Five separate posterior circulation aneurysms and bilateral internal carotid artery occlusion were identified in one patient. Three of the aneurysms were treated surgically. Access to the fourth aneurysm was deemed difficult because of its location and because of the previously placed surgical clips; this aneurysm was treated by endovascular approaches that provided optimum therapy in this unusual multiple aneurysms case.
  
  
  CONCLUSIONS
  We have described an unusual case of multiple posterior circulation aneurysms in the setting of bilateral internal carotid occlusions, treated by a combination of surgical and endovascular therapies. We will be able to provide safer treatment for such difficult cases in the future.
authors.affiliation: Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Mitakashi, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Konishi
authors.forename: E
authors.initials: E
authors.lastname: Sato
authors.forename: Y
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: H
authors.initials: H
authors.lastname: Yazaki
authors.forename: M
authors.initials: M
authors.lastname: Hara
authors.forename: I
authors.initials: I
authors.lastname: Saito
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed