PMC2686420_01
A. The AP view of a right internal carotid artery angiogram showing a giant fusiform aneurysm involving the petrous to cavernous parts in a 30-year-old woman.. B. The vertebral angiogram shows the extremely tortuous course of the vertebrobasilar arteries without aneurysmal dilatation.. C. The aneurysm is no longer visible on the lateral view of the right internal carotid artery angiogram after endovascular trapping.
kjr-6-125-g001.jpg
PMC2686420_01_kjr-6-125-g001.jpg
F1
A giant ICA aneurysm had been found during a previous evaluation of abducens nerve palsy on her right side in November 2001 (Fig. 1A). At that time, a tortuous basilar artery had been found, but without any aneurysmal dilatation (Fig. 1B). She had undergone endovascular trapping of the giant fusiform aneurysm, involving the petrous to cavernous parts of the right ICA, at another hospital (Fig. 1C).
A. MR imaging, taken seven months after therapeutic occlusion of the right internal carotid artery, shows a large signal void in the basilar artery area, exerting a mass effect on the brain stem.. B. Angiogram reveals a giant fusiform aneurysm of the basilar trunk, just distal to the origin of the left anterior inferior cerebellar artery.
kjr-6-125-g002.jpg
PMC2686420_01_kjr-6-125-g002.jpg
F2
On MR imaging, a giant aneurysm of the basilar artery was found to be compressing the brain stem (Fig. 2A). Cerebral angiography showed a fusiform giant aneurysm, with an irregular contour, involving the basilar trunk (Fig. 2B).
A. Angiogram, taken after the external carotid artery to middle cerebral artery bypass using the saphenous vein graft, shows a patent bypass and an adequate perfusion to the middle cerebral artery territory through the bypass.. B. Test balloon occlusion at the level of the proximal basilar artery ensures adequate perfusion to the upper parts of the brain stem and cerebellum through the left posterior communicating artery.. C. Angiogram, taken at the completion of embolization, shows near complete obliteration of the aneurysm.
kjr-6-125-g003.jpg
PMC2686420_01_kjr-6-125-g003.jpg
F3
The bypass supplied the right middle cerebral artery territory (Fig. 3A), and an adequate blood supply to the upper portion of the posterior circulation was maintained via the left posterior communicating artery (PCoA). After a test balloon occlusion at the level of the proximal basilar artery, which ensured adequate perfusion to the upper parts of the brain stem and cerebellum through the left PCoA (Fig. 3B), coil embolization of the basilar trunk aneurysm was done. PCoA was maintained well, with near-complete occlusion of the aneurysm (Fig. 3C). Postprocedural heparinization was not done.
Angiograms taken three months (A) and one year (B) post-treatment show remarkable decreases in the volume of the aneurysm and in the degree of brainstem compression.
kjr-6-125-g004.jpg
PMC2686420_01_kjr-6-125-g004.jpg
F4
MR imaging showed marked shrinkage of the aneurysm of the basilar trunk, with no evidence of brain stem compression (Fig. 4).