title: Recanalization and rupture of a giant vertebral artery aneurysm after hunterian ligation: case report.
abstract: OBJECTIVE
  Recanalization and subsequent rupture of giant aneurysms of the posterior circulation after Hunterian ligation is an extremely rare event that has been noted to occur with basilar apex, basilar trunk, and vertebrobasilar junction aneurysms. We report the case of a giant, previously unruptured right vertebral artery aneurysm, which recanalized from the contralateral vertebral artery and subsequently ruptured after previously performed angiography showed complete thrombosis of the aneurysm.
  
  
  METHODS
  A 72-year-old woman presented with headaches, ataxia, and lower extremity weakness. A giant 3-cm right vertebral artery aneurysm was found during the patient evaluation.
  
  
  METHODS
  Because of the size of the aneurysm and the absence of a discrete neck, Hunterian ligation was performed. After treatment, angiograms showed no filling of the aneurysm from either the right or left vertebral artery. Nine days later, after the patient developed lethargy and nausea, repeat angiography showed that a small portion of the aneurysmal base had recanalized. The next day, the patient had a massive subarachnoid hemorrhage and subsequently died.
  
  
  CONCLUSIONS
  We think that this is a previously undescribed complication associated with direct arterial ligation of giant vertebral artery aneurysms. Patients with aneurysms treated using Hunterian ligation need to be followed up closely. Even aneurysms that have minimal recanalization are at risk for subarachnoid hemorrhage.
authors.affiliation: Department of Neurosurgery, Stanford Stroke Center, Stanford University School of Medicine, California, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Chang
authors.forename: M P
authors.initials: MP
authors.lastname: Marks
authors.forename: G K
authors.initials: GK
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications; D002533:Cerebral Angiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D008026:Ligation; D008279:Magnetic Resonance Imaging; D011184:Postoperative Period; D012039:Regional Blood Flow / Q000502:physiology; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*