title: Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization.
abstract: BACKGROUND
  Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization.
  
  
  METHODS
  A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization.
  
  
  CONCLUSIONS
  Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option.
authors: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors: Hun-Soo
authors: HS
authors: Park
authors: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors: Ichiro
authors: I
authors: Nakagawa
authors: Department of Radiology, Nara Medical University, Nara, Japan.
authors: Takeshi
authors: T
authors: Wada
authors: Department of Radiology, Nara Medical University, Nara, Japan.
authors: Hiroyuki
authors: H
authors: Nakagawa
authors: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors: Yasuo
authors: Y
authors: Hironaka
authors: Department of Radiology, Nara Medical University, Nara, Japan.
authors: Kimihiko
authors: K
authors: Kichikawa
authors: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors: Hiroyuki
authors: H
authors: Nakase
keywords: Coil embolization; endovascular treatment; giant aneurysm; pediatrics