title: 3D computational fluid dynamics of a treated vertebrobasilar giant aneurysm: a multistage analysis.
abstract: OBJECTIVE
  The treatment of giant aneurysms of the vertebrobasilar junction remains a challenging task in neurosurgical practice, and the reference standard therapy is still under debate. Through a detailed postmortem study, we analyzed the hemodynamic factors underlying the formation and recanalization of an aneurysm located at this particular site and its anatomic configuration.
  
  
  METHODS
  An adult fixed cadaveric specimen with a known VBJ GA, characterized radiographically and treated with endovascular embolization, was studied. 3D computational fluid dynamic models were built based on the specific angioarchitecture of the specimen, and each step of the endovascular treatment was simulated.
  
  
  RESULTS
  The 3D CFD study showed an area of hemodynamic stress (high wall shear stress, high static pressure, high flow velocity) at the neck region of the aneurysm, matching the site of recanalization seen during the treatment period.
  
  
  CONCLUSIONS
  Aneurysm morphologic features, location, and patient-specific angioarchitecture are the principal factors to be considered in the management of VBJ giant aneurysms. The 3D CFD study has suggested that, in the treatment of giant aneurysms, the intra-aneurysmal environment induced by partial coil or Onyx embolization may lead to hemodynamic stress at the neck region, potentially favoring recanalization of the aneurysm.
authors.affiliation: Clinica Neurochirurgica, AOU G. Rodolico Universita' degli Studi di Catania, Italy. 82frensis82@libero.it
authors.forename: F
authors.initials: F
authors.lastname: Graziano
authors.forename: V M
authors.initials: VM
authors.lastname: Russo
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.forename: D
authors.initials: D
authors.lastname: Khismatullin
authors.forename: A J
authors.initials: AJ
authors.lastname: Ulm
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods; D015901:Angiography, Digital Subtraction / Q000379:methods; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001809:Blood Viscosity / Q000502:physiology; D002102:Cadaver; D003198:Computer Simulation; D004621:Embolization, Therapeutic / Q000295:instrumentation; D057510:Endovascular Procedures; D018056:Hemorheology / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D008954:Models, Biological; D012008:Recurrence; D019233:Retreatment; D015607:Stents; D013314:Stress, Mechanical; D013927:Thrombosis / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014655:Vascular Resistance / Q000502:physiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*