Spontaneous healing and complete disappearance of a giant basilar tip aneurysm in a child

Abstract

We report a rare case of spontaneous total thrombosis of a giant basilar tip aneurysm resulting in compression of the brainstem, diagnosed in a two-year-old child who presented with neurological deficits and third cranial nerve impairment. After conservative treatment, the giant aneurysm was completely thrombosed and the clinical symptoms were remarkably improved. MRI demonstrated dramatic shrinkage and ultimately complete disappearance of the giant aneurysm at seven month follow-up.

Figure 1

A) Non-contrast CT scan depicts a high-density mass lesion in the suprasellar and interpeduncular cisterns with compression of the brain stem. B, C, D) T1-weighted axial (B) and T2-weighted axial (C), sagittal (D) images demonstrate a partial thrombotic giant aneurysm in the distal basilar artery associated with compression and deformity of the brain stem as well as high signal edematous change on the T2-weighted images. E) Vertebrobasilar angiograms of anterioposterior view demonstrates thrombosis of the majority of the giant aneurysm in the basilar tip with small residual lumen. Vascular occlusion of the distal basilar and left superior cerebellar arteries are evident. F, G) Follow-up MRI 7 months later, axial (F) and sagittal (G) T1-weighted images reveal total spontaneous thrombosis of the giant aneurysm with remarkable shrinkage and complete disappearance of the aneurysm, there is neither compression nor mass effect of the brain stem currently.

Figure 1

A) Non-contrast CT scan depicts a high-density mass lesion in the suprasellar and interpeduncular cisterns with compression of the brain stem. B, C, D) T1-weighted axial (B) and T2-weighted axial (C), sagittal (D) images demonstrate a partial thrombotic giant aneurysm in the distal basilar artery associated with compression and deformity of the brain stem as well as high signal edematous change on the T2-weighted images. E) Vertebrobasilar angiograms of anterioposterior view demonstrates thrombosis of the majority of the giant aneurysm in the basilar tip with small residual lumen. Vascular occlusion of the distal basilar and left superior cerebellar arteries are evident. F, G) Follow-up MRI 7 months later, axial (F) and sagittal (G) T1-weighted images reveal total spontaneous thrombosis of the giant aneurysm with remarkable shrinkage and complete disappearance of the aneurysm, there is neither compression nor mass effect of the brain stem currently.