Should we treat aneurysms in perforator arteries from the basilar trunk? Review of 49 cases published in the literature and presentation of three personal cases
Restricted accessResearch articleFirst published online February, 2018
Should we treat aneurysms in perforator arteries from the basilar trunk? Review of 49 cases published in the literature and presentation of three personal cases
Basilar trunk perforator artery aneurysms are rare. Their diagnosis and treatment are difficult, controversial, and challenging. Analysis of 52 cases (49 documented in the literature and three personal cases) clearly shows a re-bleeding rate of 15% in patients whose aneurysm has not been occluded and 0% in treated patients (p < 0.05). The most effective treatment, and the one that presents the least complication, is double-stenting across the basilar trunk.
AboukaisRZairiFEstradeLet al.A dissecting aneurysm of a basilar perforating artery. Neurochirurgie2016; 62: 263–265.
2.
SattiSRVanceAZFowlerDet al.Basilar artery perforator aneurysms (BAPAs): Review of the literature and classification. J Neurointerv Surg2017; 9: 669–673.
HamelWGrzyskaUWestphaet al.Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir (Wien)2005; 147: 1283–1286.
5.
FiorellaDAlbuquerqueFCDeshmukhVRet al.Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery2006; 59: 291–300.
6.
Sanchez-MejiaROLawtonMT. Distal aneurysms of basilar perforating and circumferential arteries. Report of three cases. J Neurosurg2007; 107: 654–659.
7.
ParkSQKwonOKKimSHet al.Pre-mesencephalic subarachnoid hemorrhage: Rupture of tiny aneurysms of the basilar artery perforator. Acta Neurochir (Wien)2009; 151: 1639–1646.
8.
MathiesonCSBarlowPJenkinsSet al.An unusual case of spontaneous subarachnoid haemorrhage – a ruptured aneurysm of a basilar perforator artery. Br J Neurosurg2010; 24: 291–293.
9.
DeshaiesEJacobsenWKrishnamurthyS. Enterprise stent-within-stent embolization of a basilar artery perforator aneurysm. World J Neurosci2011; 1: 45–48.
10.
ChenLChenEChotaiSet al.An endovascular approach to ruptured aneurysms of the circumferential branch of the basilar artery. J Clin Neurosci2012; 19: 527–531.
11.
NybergEMChaudryMITurkASet al.Report of two cases of a rare cause of subarachnoid hemorrhage including unusual presentation and an emerging and effective treatment option. J Neurointerv Surg2013; 5: e30.
12.
GrossBAPuriASDuR. Basilar trunk perforator artery aneurysms. Case report and literature review. Neurosurg Rev2013; 36: 163–168.
13.
ApokVTarnarisABrydonHL. An unusual aneurysm of a basilar perforating artery presenting with a subarachnoid haemorrhage. Br J Neurosurg2013; 27: 105–107.
14.
DingDStarkeRMJensenMEet al.Perforator aneurysms of the posterior circulation: Case series and review of the literature. J Neurointerv Surg2013; 5: 546–551.
15.
KimYJKoJH. Sole stenting with large cell stents for very small ruptured intracranial aneurysms. Interv Neuroradiol2014; 20: 45–53.
ChalouhiNJabbourPStarkeRMet al.Treatment of a basilar trunk perforator aneurysm with the pipeline embolization device: Case report. Neurosurgery2014; 74: E697–E701.
18.
ChaventALefevrePHThouantPet al.Spontaneous resolution of perforator aneurysms of the posterior circulation. J Neurosurg2014; 121: 1107–1111.
19.
SivakanthanSCarlsonAPvan LoverenHet al.Surgical clipping of a basilar perforator artery aneurysm: A case of avoiding perforator sacrifice. J Neurol Surg A Cent Eur Neurosurg2015; 76: 79–82.
20.
ForbrigREckertBErtlLet al.Ruptured basilar artery perforator aneurysms – treatment regimen and long-term follow-up in eight cases. Neuroradiology2016; 58: 285–291.
21.
DaruwallaVJSyedFHElmokademAHet al.Large basilar perforator pseudoaneurysm: A case report. Interv Neuroradiol2016; 22: 662–665.
22.
FinitsisSDerelleALTonneletRet al.A dissecting aneurysm of a basilar perforating artery. Basilar perforator aneurysms: Presentation of 4 cases and review of the literature. World Neurosurg2017; 97: 366–373.
23.
Buell TJ, Ding D, Raper DM, et al. Posterior circulation perforator aneurysms: A proposed management algorithm. Neurointerv Surg. Epub ahead of print 6 January 2017. DOI: 10.1136/neurintsurg-2016-012891.
24.
DarsautTECostalatVSalazkinIet al.Fatal avulsion of choroidal or perforating arteries by guidewires. Case reports, ex vivo experiments, potential mechanisms and prevention. Interv Neuroradiol2014; 20: 251–260.
25.
MarinkovićSVGiboH. The surgical anatomy of the perforating branches of the basilar artery. Neurosurgery1993; 33: 80–87.
26.
CantónGLevyDILasherasJCet al.Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms. J Neurosurg2005; 103: 891–902.
27.
LieberBBLivescuVHopkinsLNet al.Particle image velocimetry assessment of stent design influence on intra-aneurysmal flow. Ann Biomed Eng2002; 30: 768–777.
28.
BouillotPBrinaOOuaredRet al.Particle imaging velocimetry evaluation of intracranial stents in sidewall aneurysm: Hemodynamic transition related to the stent design. PLoS One2014; 9: e113762.
29.
RoszelleBNBabikerMHHafnerWet al.In vitro and in silico study of intracranial stent treatments for cerebral aneurysms: Effects on perforating vessel flows. J Neurointerv Surg2013; 5: 354–360.
30.
PhillipsTJWenderothJDPhatourosCCet al.Safety of the pipeline embolization device in treatment of posterior circulation aneurysms. AJNR Am J Neuroradiol2012; 33: 1225–1231.
