title: Giant thrombosed fusiform aneurysm at the basilar trunk successfully treated with endovascular coil occlusion following bypass surgery: a case report and review of the literature.
abstract: OBJECTIVE
  Giant fusiform aneurysms at the basilar trunk tend to have a poor natural history, and the surgical management for these aneurysms remains controversial. For these aneurysms, basilar trunk occlusion may offer a potentially long-lasting cure. However, the strategy for these aneurysms is difficult when the collateral supply from the carotid circulation is poor. The authors herein present a successful case of a thrombosed giant fusiform aneurysm at the basilar trunk with a poor collateral supply using repeated balloon test occlusion (BTO) and a second bypass surgery.
  
  
  METHODS
  A 46-year-old female was admitted to our institute because of progressing double vision. A radiologic examination revealed a thrombosed giant fusiform aneurysm at the upper basilar trunk, and the collateral supply from carotid circulation was poor. We attempted to perform a second bypass surgery before the basilar trunk coil occlusion due to intolerance after the repeated BTO. After confirmation of her tolerance against the third BTO, the aneurysm was successfully trapped using the endovascular technique.
  
  
  CONCLUSIONS
  Various kind of bypass surgery should be tried for endovascular trapping of giant fusiform basilar trunk aneurysms, and repeated BTO is necessary to confirm the tolerance after bypass surgery especially for the complex aneurysms without a sufficient collateral supply.
authors: Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan. nhorienagasaki@yahoo.co.jp
authors: Nobutaka
authors: N
authors: Horie
authors: Naoki
authors: N
authors: Kitagawa
authors: Minoru
authors: M
authors: Morikawa
authors: Junichi
authors: J
authors: Kawakubo
authors: Keisuke
authors: K
authors: Tsutsumi
authors: Makio
authors: M
authors: Kaminogo
authors: Izumi
authors: I
authors: Nagata
mesh_terms: D021721:Balloon Occlusion; D001488:Basilar Artery / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged