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Essibayi MA, Srinivasan VM, Madriñán-Navia HJ, Park MT, Scherschinski L, Catapano JS, Rhodenhiser EG, Graffeo CS, Ducruet AF, Albuquerque FC, Lawton MT. Management of basilar fenestration aneurysms: a systematic review with an illustrative case report. J Neurointerv Surg 2023; 16:24-30. [PMID: 36564200 DOI: 10.1136/jnis-2022-019728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Basilar artery (BA) fenestration aneurysm (BAFA) is a rare phenomenon commonly accompanying other aneurysms. Treatment is challenging, and few cases have been reported. This review investigated the management outcomes of BAFAs. METHODS Publication databases were searched to identify studies evaluating outcomes of endovascular treatment (EVT) and microsurgical treatment of BAFAs from inception through 2021. Outcomes (clinical, angiographic, postoperative complications, and retreatment rates) were collected and analyzed. The authors present their case of a patient treated for a BAFA. RESULTS Including the authors' case, 184 patients with 209 BAFAs were reported in 68 studies. Most patients (130/175; 74.3%) presented with ruptured aneurysms, most commonly involving the proximal segment of the BA. Most BAFAs were small (52/103, 50.5%) and saccular (119/143, 83.2%). Most patients underwent EVT (143/184, 77.7%); the rest underwent microsurgery. Postoperative complications after EVT occurred in 10 (8.3%) of 120 patients, with 4 of the 10 experiencing strokes. At clinical follow-up, most EVT patients (74/86, 86.0%) showed good outcomes; 3.9% (2/51) had died. Most aneurysms managed with EVT (56/73, 76.7%) showed complete occlusion at follow-up; 7.3% (8/109) were retreated. Postoperative complications occurred in 62.2% (23/37) of microsurgical patients; 5 (21.7%) of the 23 experienced strokes. All patients showed good clinical outcomes at follow-up. Most aneurysms (22/28, 78.6%) treated microsurgically showed complete occlusion at angiographic follow-up, with no retreatment required. CONCLUSION BAFAs are often symptomatic; thus, treatment is challenging. By the 2000s, treatment had moved from microsurgical to endovascular modalities, with good clinical and angiographic outcomes.
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Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Humberto José Madriñán-Navia
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | - Marian T Park
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Emmajane G Rhodenhiser
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Matsuo A, Hiu T, Otsuka H, Miyazaki A, Haraguchi W, Kawahara I, Ono T, Izumo T, Matsuo T, Tsutsumi K. Endovascular treatment of an aneurysm arising from the minor limb of an upper basilar artery fenestration: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22180. [PMID: 36046266 PMCID: PMC9329865 DOI: 10.3171/case22180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
An aneurysm arising in an upper basilar artery (BA) fenestration is extremely rare. The authors reported a case involving successful endovascular treatment of an aneurysm arising from the minor limb of an upper BA fenestration.
OBSERVATIONS
A 65-year-old woman presented with an incidentally detected upper BA aneurysm arising from the minor limb of an upper BA fenestration. The irregularly shaped aneurysm was 6.0 × 2.7 mm in diameter, and the minor limb had several perforators. The aneurysm was nearly completely occluded with a catheter-assisted technique. The authors preserved both limbs of the BA fenestration. The postoperative course was uneventful, and the patient had an excellent clinical course with no neurological deficits or aneurysmal recanalization.
LESSONS
The case is the first report of an unruptured aneurysm arising at the minor limb of an upper BA fenestration. In this case, the authors preserved the minor limb with endovascular treatment. The authors believe catheter-assisted coil embolization to be a feasible endovascular technique in such cases.
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Affiliation(s)
- Ayaka Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
| | - Takeshi Hiu
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
| | | | - Atsushi Miyazaki
- Radiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | | | | | | | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
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Korkmaz M, Çınar C, Nas ÖF, Hakyemez B, Oran İ. Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review. Turk J Med Sci 2021; 51:1049-1057. [PMID: 33356025 PMCID: PMC8283513 DOI: 10.3906/sag-2006-352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure. Results Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively. Conclusion Although the number of cases is low in our study, to our knowledge, it is the widest series in the literature until today. Our results demonstrate that BAF aneurysms can be treated successfully and safely with different endovascular techniques, with more stent use in recent years.
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Affiliation(s)
- Mehmet Korkmaz
- Department of Radiology, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Celal Çınar
- Department of Radiology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ömer Fatih Nas
- Department of Radiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - İsmail Oran
- Department of Radiology, Faculty of Medicine, Ege University, İzmir, Turkey
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Sturiale CL, Stifano V, Della Pepa GM, Albanese A, Fernandez E, Marchese E, Puca A, Sabatino G, Olivi A. Intracranial aneurysms of the posterior circulation associated with a fenestration: a systematic review. J Neurosurg Sci 2019; 63:588-599. [DOI: 10.23736/s0390-5616.18.04225-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sirakov SS, Panayotova AP, Sirakov AS, Hristov H, Minkin K, Raychev R. Fenestration of the Basilar Artery Associated with Aneurysm Treated by the Support of a Temporary Bridging Device—Comaneci: A Case Report. World Neurosurg 2018; 119:306-310. [DOI: 10.1016/j.wneu.2018.08.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022]
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Joshi KC, Thomas A, Jagannatha AT, Garg D. Stent-Assisted Coiling of Aneurysm in a Persistent Primitive Lateral Vertebrobasilar System. World Neurosurg 2015; 86:513.e9-14. [PMID: 26409091 DOI: 10.1016/j.wneu.2015.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 11/18/2022]
Abstract
Fenestrations of cerebral arteries are relatively common. Knowledge of their structure has recently gained clinical significance with increasing awareness of fenestration aneurysms. Persistent primitive lateral vertebrobasilar (PPLVB) anastomoses are an extreme end of the embryologic mishaps causing these fenestrations, and their occurrence has only been reported twice. We report the first case of an aneurysm within the PPLVB in a patient with unilateral subclavian stenosis. The unique anatomy of these aneurysms and relation with important perforators and brainstem make surgery extremely difficult and require advanced endovascular techniques like balloon remodeling and stent assistance. Three-dimensional rotational angiography can help in providing clarity to the aneurysmal anatomy and planning treatment. The purpose of this case report is to bring to notice the possibility of such aneurysms and use the unique anatomy to understand various tools available in the endovascular surgeon's armamentarium.
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Affiliation(s)
- Krishna Chaitanya Joshi
- Institute of Neurosciences, M S Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore, Karnataka, India.
| | | | - Aniruddha T Jagannatha
- Institute of Neurosciences, M S Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore, Karnataka, India
| | - Deepali Garg
- Department of Neuroanesthesia, NIMHANS, Bangalore, India
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Toth G, Hui F, Bain M. Fenestra Obscura: Flow Diverter Reconstruction of a Complex Vertebrobasilar Aneurysm Through an Obscured Fenestration Limb: Technical Case Report. Oper Neurosurg (Hagerstown) 2015; 12:E95-E100. [DOI: 10.1227/neu.0000000000000996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Basilar fenestration aneurysms are rare, challenging intracranial vascular lesions with atypical anatomy. The posterior circulation represents a difficult therapeutic dilemma because of the close proximity of crucial life-sustaining brainstem structures. The use of flow diverter technology has been very limited in posterior circulation vessels.
CLINICAL PRESENTATION
We present the case of a 49-year-old female patient, who was diagnosed with a symptomatic large vertebrobasilar junction aneurysm, which was initially thought to be a proximal basilar dilatation. The aneurysm was later verified to arise from the proximal end of a basilar fenestration, distended by the aneurysm fundus. The small-caliber fenestration limbs were the only connection to the distal basilar artery, but were stretched laterally and concealed by the aneurysm fundus. This complex lesion was successfully treated by flow diverter deployment through one of the fenestration limbs, followed by coiling of the aneurysm fundus, and sacrificing the contralateral vertebral artery. A 6-month follow-up angiogram showed remodeling of the basilar artery and complete occlusion of the aneurysm with good clinical outcome. Careful diagnostic workup, multidisciplinary discussions, and the innovative use of versatile endovascular technology were crucial to achieve an optimal result in this case.
CONCLUSION
This is the first report of a successful basilar artery reconstruction for the treatment of a large atypical vertebrobasilar junction fenestration aneurysm by deployment of a flow diverter device directly in a small, obscured fenestration limb.
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Affiliation(s)
- Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Ferdinand Hui
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Mark Bain
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
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Trivelato F, Abud D, Nakiri G, de Castro Afonso L, Ulhôa A, Manzato L, Rezende M. Basilar Artery Fenestration Aneurysms: Endovascular Treatment Strategies Based on 3D Morphology. Clin Neuroradiol 2014; 26:73-9. [DOI: 10.1007/s00062-014-0336-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
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Cooke DL, Stout CE, Kim WT, Kansagra AP, Yu JP, Gu A, Jewell NP, Hetts SW, Higashida RT, Dowd CF, Halbach VV. Cerebral arterial fenestrations. Interv Neuroradiol 2014; 20:261-74. [PMID: 24976087 DOI: 10.15274/inr-2014-10027] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 01/01/2014] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Daniel L Cooke
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA -
| | - Charles E Stout
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Warren T Kim
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Akash P Kansagra
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - John Paul Yu
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Amy Gu
- University of California; Berkeley, CA, USA
| | | | - Steven W Hetts
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Randall T Higashida
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Christopher F Dowd
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
| | - Van V Halbach
- Department of Radiology & Biomedical Imaging, University of California; San Francisco, CA, USA
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Yoshida M, Ezura M, Sasaki K, Chonan M, Mino M. Endovascular repair of ruptured aneurysm arising from fenestration of the horizontal segment of the anterior cerebral artery: case report. Neurol Med Chir (Tokyo) 2012; 52:924-7. [PMID: 23269052 DOI: 10.2176/nmc.52.924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 50-year-old man presented with an aneurysm arising from a fenestration of horizontal portion (A(1)) of the anterior cerebral artery manifesting as subarachnoid hemorrhage. Coil embolization was conducted and the aneurysm was occluded easily. Most reported cases of these types of aneurysms underwent direct surgery. Aneurysm arising from the A(1) fenestration is rare, but the present case shows that coil embolization can be an effective treatment modality. Three-dimensional rotational angiography and aneurysmography were helpful to characterize this complicated vascular structure.
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Affiliation(s)
- Masahiro Yoshida
- Department of Neurosurgery, Osaki Citizen Hospital, Osaki, Miyagi.
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