Ruptured vertebrobasilar junction aneurysm associated with basilar artery fenestration

Cerebral arterial fenestrations

Arterial fenestrations are an anatomic variant with indeterminate significance. Given the controversy surrounding fenestrations we sought their prevalence within our practice along with their association with other cerebrovascular anomalies. We retrospectively reviewed 10,927 patients undergoing digital subtraction angiography between 1992 and 2011. Dictated reports were searched for the terms "fenestration" or "fenestrated" with images reviewed for relevance, yielding 228 unique cases. A Medline database search from February 1964 to January 2013 generated 304 citations, 127 cases of which were selected for analysis. Cerebral arterial fenestrations were identified in 228 patients (2.1%). At least one aneurysm was noted in 60.5% of patients, with an aneurysm arising from the fenestration in 19.6% of patients. Aneurysmal subarachnoid hemorrhage or non-aneurysmal subarachnoid hemorrhage were present in 60.1% and 15.8%, respectively. For the subset of patients with an aneurysm arising directly from a fenestration relative to those patients with an aneurysm not immediately associated with a fenestration, the prevalence of aneurysmal subarachnoid hemorrhage was 66.7% vs. 58.6% (p = 0.58). Fenestrations were more often within the posterior circulation (73.2%) than the anterior circulation (24.6%), though there was no difference in the prevalence of aneurysms within these groups (61.1% vs. 60.7%, p = 1.0). Cerebral arterial fenestrations are an anatomic variant more often manifesting at the anterior communicating arterial complex and basilar artery and with no definite pathological relationship with aneurysms.

Endovascular management of multiple cerebral aneurysms in acute subarachnoid hemorrhage associated with fenestrated basilar artery. A case report and literature review

Aneurysms arising from the fenestration of the basilar artery are rare. We describe a patient with two aneurysms originating from the fenestration of the basilar artery and the middle cerebral artery. Endovascular treatment with detachable platinum coils was performed, and two aneurysms were cured at the same time. Endovascular treatment of aneurysms associated with fenestrated basilar artery appears to offer advantages over traditional open surgical techniques.

Endovascular treatment of kissing aneurysms at the fenestrated basilar artery. Case report with literature review

BACKGROUND

Basilar artery fenestrations are most commonly located in the proximal basilar trunk close to the vertebrobasilar junction and may harbor saccular aneurysms. Surgical treatment of such aneurysms has been reported in several cases previously, despite the difficulty of the surgical approach. Endovascular treatment may provide a more convenient treatment alternative in such cases. This case is also interesting in that two discrete aneurysms arise from each limb of the fenestration.

CASE REPORT

A 20-year-old man presented with acute subarachnoid hemorrhage. He had two kissing aneurysms at the fenestrated proximal basilar artery as demonstrated by MRA and selective angiography. The two aneurysms were successfully treated with GDCs via the contralateral vertebral arteries. One-year control angiogram showed stable occlusion.

CONCLUSION

Aneurysms at the fenestrated basilar artery may be effectively treated with endovascular coil occlusion. The occurrence of multiplicity and the treatment alternatives are discussed, with relevant literature review.

Fenestration of the posteroinferior cerebellar artery: case report

OBJECTIVE AND IMPORTANCE

Fenestrations of cerebral arteries are rare, but very important to diagnose given their high association with saccular aneurysms. We present the first reported case of a fenestration of the posteroinferior cerebellar artery (PICA).

CLINICAL PRESENTATION

A 62-year-old man who presented with a subarachnoid hemorrhage underwent repeated four-vessel cerebral angiography. An isolated right PICA abnormality consistent with a dissection or fenestration was revealed.

INTERVENTION

The patient underwent surgical exploration of his PICA, which confirmed a PICA fenestration without an associated saccular aneurysm. The fenestration was wrapped with cotton.

CONCLUSION

Our case report illustrates the novel anatomic finding of a fenestration of the PICA. Knowledge of this entity would be helpful in the differential diagnosis of a posterior fossa subarachnoid hemorrhage.