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. 2023 Jan 20:14:23.
doi: 10.25259/SNI_961_2022. eCollection 2023.

Treatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus

Shinichiro Yoshida  1 , Kaisei Kamatani  1 , Kousei Maruyama  1 , Yoshiaki Hama  1 , Noriaki Tashiro  1 , Fumihiro Hiraoka  1 , Shigetoshi Yano  1 , Hiroshi Aikawa  1 , Yoshinori Go  1 , Kiyoshi Kazekawa  1
Affiliations

Treatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus

Shinichiro Yoshida et al. Surg Neurol Int. .

Abstract

Background: There is no established adequate treatment for thrombosed aneurysm of the basilar artery with obstructive hydrocephalus. We conducted coil embolization and peritoneal shunting followed by placement of a stent expected to exert flow diversion (FD) effects to treat 2 patients with giant thrombosed aneurysms of the basilar artery with associated obstructive hydrocephalus, with good results.

Methods: From April 2019 to March 2021, consecutive two cases of symptomatic hydrocephalus due to giant thrombosed aneurysms in the posterior cranial fossa at our hospital were treated. At first, coil embolization was performed to prevent aneurysm rupture. After coil embolization, ventriculoperitoneal shunting was performed. Finally, stent-assisted coil embolization was performed with flow re-direction endoluminal device (FRED) or low-profile visualized intraluminal support device (LVIS) stent.

Results: Both patients were discharged after recovering well, with no postoperative hemorrhagic or ischemic complications.

Conclusion: Staged surgery using a FRED for flow diverter or an LVIS stent expected to have FD effects may offer an effective treatment option.

Keywords: Flow re-direction endoluminal device; Hydrocephalus; Low-profile visualized intraluminal support device; Neuroendovascular; Thrombosed aneurysm.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Preoperative images of case# 1 and case# 2. (a) Axial T2-weighted MRI. (b) Axial and coronal CT. Ventricular enlargement with Evans index>0.3, sharpening of the callosal angle, and disproportionately enlarged subarachnoid space hydrocephalus were observed. (c) Frontal digital subtraction angiography (DSA). (d) Lateral DSA.
Figure 2:
Figure 2:
Postoperative and preoperative images of the first coil embolization for cases #1 and #2. (a) Preoperative frontal digital subtraction angiography (DSA). (b) Preoperative lateral DSA. (c) Postoperative frontal DSA. (d) Postoperative lateral DSA.
Figure 3:
Figure 3:
Postoperative and preoperative images of the second coil embolization and stent employment for cases #1 and #2. The proximal part of the aneurysm has enlarged compared to immediately after the initial procedure. We considered that the aneurysm had enlarged as a result of coil embolization of the thrombosed aneurysm. #1(a) Preoperative frontal digital subtraction angiography (DSA). #1(b) Preoperative lateral DSA. #1(c) Postoperative frontal DSA. #1(d) Postoperative lateral DSA. #1(e) Cone-beam computed tomography (CT). #2(a) Preoperative frontal DSA. #2(b) Preoperative lateral DSA. #2(c) Postoperative frontal image in cone-beam CT. #2(d) Postoperative lateral image in cone-beam CT.
Figure 4:
Figure 4:
(a) Frontal digital subtraction angiography (DSA) at 11 months postoperatively in case #1. (b) Lateral DSA at 11 months postoperatively in case #1. No recurrence of the aneurysm has been identified.
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