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Case Reports
. 2020 Jun 26;7(3):93-100.
doi: 10.2176/nmccrj.cr.2019-0143. eCollection 2020 Jul.

Ruptured Basilar Artery Perforator Aneurysm: A Case Report and Review of the Literature

Noriya Enomoto  1 , Kiyohito Shinno  1 , Tetsuya Tamura  1 , Eiji Shikata  1 , Kenji Shono  1 , Kensaku Takase  1
Affiliations
Case Reports

Ruptured Basilar Artery Perforator Aneurysm: A Case Report and Review of the Literature

Noriya Enomoto et al. NMC Case Rep J. .

Abstract

Basilar artery perforator aneurysms (BAPAs) are a rare cause of subarachnoid hemorrhage (SAH), and the natural history is still unknown. Herein, we report a case of ruptured BAPA that appeared during the observation period and then spontaneously disappeared; we have also conducted a review of the literature and performed an analysis based on the type of management. This case of BAPA had a unique course, and our observations may help establish a treatment strategy. A 60-year-old man presented with acute diffuse SAH, World Federation of Neurosurgical Societies (WFNS) Grade II and Fisher Grade 3. Initial three-dimensional digital subtraction angiography (DSA) did not show the source of the hemorrhage. DSA performed on day 39 showed a BAPA with a diameter of 3 mm at the posterior surface of the upper third of the basilar artery. Conservative treatment was chosen. DSA performed on day 64 showed complete resolution of the aneurysm. BAPAs are likely pseudoaneurysms, and not saccular aneurysms, caused due to dissection of basilar perforator arteries. BAPAs are often not recognized on initial imaging, and hence, it is necessary to repeat the DSA examination. Considering the relatively high rate of spontaneous resolution, we chose conservative management. When BAPAs enlarge or do not disappear after conservative treatment, additional therapy such as multiple stents should be considered.

Keywords: basilar artery perforator aneurysm; subarachnoid hemorrhage.

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Conflict of interest statement

Conflicts of Interest Disclosure All authors have no conflicts of interest regarding this article. All authors who are members of The Japan Neurosurgical Society (JNS) have registered with the online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Figures

Fig. 1
Fig. 1
Non-contrast CT of the head demonstrated ventriculomegaly and diffuse subarachnoid hemorrhage predominantly in the perimesencephalic cistern (Fisher Grade 3). CT: computed tomography.
Fig. 2
Fig. 2
(A) Initial DSA was negative for the source of hemorrhage. (B) DSA performed on day 39 showed a 3 mm aneurysm (arrow) at the posterior surface of the upper third of the basilar artery. (C) The aneurysm (arrow) was observed in the late arterial phase of the same DSA, as shown in (B), without directly involving the basilar trunk. (D) DSA performed on day 64 showed complete resolution of the aneurysm. DSA: digital subtraction angiography.
See this image and copyright information in PMC

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