Progressive growth of a giant dolichoectatic vertebrobasilar artery aneurysm after complete Hunterian occlusion of the posterior circulation: case report.
OBJECTIVE
Dolichoectatic vertebrobasilar artery aneurysms are often extremely difficult, if not impossible, to treat with microneurosurgical clip reconstruction. As such, a Hunterian strategy via vertebral or basilar artery sacrifice is often used. We have encountered a patient in whom deliberate bilateral vertebral artery sacrifice was insufficient to avoid progressive expansion of a giant dolichoectatic vertebrobasilar artery aneurysm. On the basis of a review of the literature, we are unaware of another reported case.


METHODS
A 60-year-old man presented with signs and symptoms of brainstem compression from a large fusiform aneurysm involving the distal dominant vertebral and proximal basilar arteries. Results of angiographic evaluation were highly characteristic of underlying dolichoectasia.


METHODS
The patient was treated initially with staged bilateral vertebral artery occlusion and adjunctive posterior circulation revascularization. After this therapy failed, he underwent a trapping procedure and aneurysm deflation.


CONCLUSIONS
Unclippable aneurysms of the vertebrobasilar system are formidable lesions. They are not uniformly treatable by direct surgical reconstruction, and their growth is not consistently stabilized by the implementation of a complete Hunterian strategy. Future developments related to the use of endovascular stent technology may offer a more successful treatment approach for patients with these complex cerebrovascular lesions.
O'Shaughnessy
Brian A
BA
Department of Neurological Surgery, Northwestern University, McGaw Medical Center, 233 East Erie Street, Suite 614, Chicago, IL 60611, USA. branos@md.northwestern.edu
Getch
Christopher C
CC
Bendok
Bernard R
BR
Parkinson
Richard J
RJ
Batjer
H Hunt
HH
D001488:Basilar Artery / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003251:Constriction, Pathologic / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D017211:Treatment Failure; D014711:Vertebral Artery / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000601:surgery*