title: Radical surgical treatment for recurrent giant fusiform thrombosed vertebral artery aneurysm previously coiled.
abstract: BACKGROUND
  Fusiform aneurysms are rare (<1%) and the underlying pathophysiology is not well known. Endovascular coiling is the standard of treatment; however, a surgical procedure with vascular reconstruction by excluding the pathological segment of the vessel and restoring the blood flow, seems to be the most effective and definitive treatment.
  
  
  METHODS
  We report a patient who presented a fusiform vertebral artery aneurysm previously coiled which developed a giant enlargement and a new contralateral fusiform aneurysm. Hemodynamic changes resulting in the formation of contralateral aneurysm might be the result of aneurysm occlusion without revascularization. In addition, continued blood flow to the aneurysmal wall through the vasa vasorum might result in aneurysm recanalization or regrowth. In order to account for these possible sources of complications, we performed a vascular reconstruction with high and low flow bypasses after trapping the aneurysm.
  
  
  CONCLUSIONS
  We hypothesize that, in this and similar cases, surgical vascular reconstruction should be the first and definitive treatment under experienced cerebrovascular surgeons.
authors.affiliation: Department of Neurosurgery, University Hospital Dr. Negrín, Gran Canaria, Canary Islands, Spain.
authors.forename: Aruma
authors.initials: A
authors.lastname: J-O'Shanahan
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
keywords: Endovascular coiling; fusiform aneurysm; revascularization; vasa vasorum; vertebral artery