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. 2025;19(1):2025-0043.
doi: 10.5797/jnet.oa.2025-0043. Epub 2025 Jul 25.

Basilar Artery Perforator Aneurysms: A Single-Center Experience with Conservative Management

Alejandro Venegas  1 , Keren Zambrano  1 , Mario Echeverria  1 , Juan Pablo Cruz  1 , Eduardo Bravo  1 , Juan Gabriel Sordo  1 , Rodrigo Rivera  1
Affiliations

Basilar Artery Perforator Aneurysms: A Single-Center Experience with Conservative Management

Alejandro Venegas et al. J Neuroendovasc Ther. 2025.

Abstract

Objective: Basilar artery perforating aneurysms (BAPAs) represent an infrequent clinical finding, typically manifesting as subarachnoid hemorrhage (SAH). Consensus on the optimal management of this rare entity is lacking. We report a single-center case series of 11 patients diagnosed with BAPAs, providing a detailed description of their clinical presentation, management course, and follow-up.

Methods: A retrospective review of our institutional aneurysm database was performed, encompassing cases treated between January 2008 and 2024. Inclusion criteria required aneurysm localization to the middle or upper 3rd of the basilar artery.

Results: All cases presented with diffuse SAH, with 80% exhibiting a perimesencephalic cisternal bleeding pattern. Notably, in most cases, aneurysms were detected upon repeat angiography, performed approximately 10 days after the initial angiographic study. A conservative management strategy was employed, resulting in spontaneous aneurysm exclusion in 80% of the cohort. No instances of rebleeding were observed during the follow-up period.

Conclusion: Conservative management demonstrated favorable functional outcomes in our case series, marked by a high rate of spontaneous thrombosis. These findings suggest that conservative management is an effective and potentially preferred treatment strategy for this rare pathology, mitigating perioperative risks associated with surgical or endovascular interventions.

Keywords: basilar artery perforating aneurysms; conservative management; subarachnoid hemorrhage.

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Figures

Fig. 1
Fig. 1. (A) Coronal oblique MIP from a DSA and (B) 3D volume rendering of the basilar artery. Both images show a BAPA in the right superior 3rd portion of the artery (arrow). No vasospasm was observed. BAPA, basilar artery perforating aneurysm; MIP, maximum intensity projection
Fig. 2
Fig. 2. (A) 3D volume rendering and (B) DSA of the basilar artery. Both images depict a BAPA in the left superior 3rd portion of the artery (arrow). BAPA, basilar artery perforating aneurysm
Fig. 3
Fig. 3. CT of the posterior fossa at the pontine (A) and medullary (B) levels, demonstrating subarachnoid hemorrhage with a perimesencephalic pattern (arrows).
Fig. 4
Fig. 4. (A) DSA and (B) 3D volume rendering of the basilar artery at diagnosis, with the arrow indicating a BAPA in the right superior one-third segment. (C) Three-month follow-up 3D volume rendering demonstrating complete resolution of the BAPA (arrows). BAPA, basilar artery perforating aneurysm
See this image and copyright information in PMC

References

    1. Ghogawala Z, Shumacher JM. Ogilvy CS: Distal basilar perforator artery aneurysm: case report. Neurosurgery 1996; 39: 393–396. - PubMed
    1. Satti SR, Vance AZ, Fowler D, et al. Basilar artery perforator aneurysms (BAPAs): review of the literature and classification. J Neurointerv Surg 2017; 9: 669–673. - PubMed
    1. Granja MF, Monteiro A, Agnoletto GJ, et al. A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish? J Neurointerv Surg 2020; 12: 412–416. - PubMed
    1. Ding D, Starke RM, Jensen ME, et al. Perforator aneurysms of the posterior circulation: case series and review of the literature. J Neurointerv Surg 2013; 5: 546–551. - PubMed
    1. Gardijan D, Herega T, Premužić V, et al. Comparison between stenting and conservative management of posterior circulation perforator aneurysms: systematic review and case series. Neuroradiology 2021; 63: 639–651. - PubMed