title: Dissecting giant vertebro-basilar aneurysms.
abstract: OBJECTIVE
  Vertebro-basilar dissecting aneurysms (VDAs) are very rare in children. Strokes or subarachnoid hemorrhage are characteristic clinical manifestations, but often only non-specific symptoms are found. Radiological diagnosis may be difficult to obtain and therapy hard to perform. We report on a child who presented with an intracranial mass effect due to a giant VDA.
  
  
  METHODS
  The patient was a 8-year-old girl with right hemiparesis, ataxia, dysphagia and dysphonia and worsening of her neurological deficits. Neuroimaging discovered a giant dissecting aneurysm arising from the left vertebral artery and involving the vertebro-basilar junction. Endovascular treatment by coil embolization was performed. The post-operative course initially showed a remarkable improvement in her clinical condition. Afterwards, she developed cerebral hemorrhage and died.
  
  
  CONCLUSIONS
  VDAs may have an unusual presentation and their therapy still remains a challenge. Endovascular embolization is a valid option but, as it is surgery, it may cause the death of the patient.
authors.affiliation: Pediatric Neurosurgery, Catholic University School of Medicine, Largo A. Gemelli, 8, 00168 Rome, Italy. lucamax30@hotmail.com
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.forename: Jacques
authors.initials: J
authors.lastname: Moret
authors.forename: Giampiero
authors.initials: G
authors.lastname: Tamburrini
authors.forename: Concezio
authors.initials: C
authors.lastname: Di Rocco
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy; D001488:Basilar Artery; D002533:Cerebral Angiography; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery