Giant Fusiform Basilar Artery Aneurysm Causing Obstructive Hydrocephalus

Abstract

A 58-year-old man presented with a sudden onset gait disturbance and urinary incontinence. Magnetic resonance (MR) imaging and MR angiography showed a fusiform basilar artery aneurysm, 2 cm in diameter and 5 cm long. The aneurysm was thrombosed except the ectatic basilar artery flowing through it. Compression of the cerebrospinal fluid (CSF) pathways caused obstructive hydrocephalus with resultant transependymal CSF leakage. Conventional angiography missed the aneurysm. A one-sided ventriculoperitoneal shunt was placed to treat the patient's hydrocephalus. The patient's symptoms improved after surgery. MR imaging and MR angiography were useful noninvasive methods of detecting the aneurysm, defining its relationship with surrounding structures, and determining the cause of the hydrocephalus.

Intracranial Aneurysms Mimicking Third Ventricular and adjoining parts Masses Associated with Obstructive Hydrocephalus: Diagnosis and Treatment

“…Magnetic resonance angiography (MRA) was used in some cases alongside DSA with no reports of misdiagnosis in cases we collected, and one case reported a positive result on MRA and negative result on DSA. 24 The DSA for case 3 in our series also did not obtain patent results because of thrombosis and calci cation, the diagnosis was made comprehensively according to VW-MRI, CT, and DSA, suggesting that DSA is not the only choice for the diagnosis of giant aneurysms. DSA evaluates the circulation of aneurysms, which is not enough for complex cases such as aneurysms presenting as a third ventricular mass.…”

“…We reviewed the literature from PubMed and Embase databases and identi ed 27 cases of aneurysms (including the cases above) presenting as third ventricular masses. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The average age of the patients was 62 years (range, 14-82 years). In previse cases, all patients were middle-aged and elderly, with one of our cases (case 1) being the rst adolescent reported.…”

“…Third ventricular and adjoining parts masses, including various tumors such as germ cell tumors, glial cell tumors, craniopharyngiomas, 1 meningioma, ependymomas, choroid plexus tumors, 2-4 epidermoid cysts, 5,6 and various vascular malformations 7 can cause obstruction of cerebral spinal uid (CSF) ow and result in hydrocephalus. Identifying the pathological histology of this area is of great clinical importance, especially for rare intracranial aneurysms [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] . These intracranial aneurysms are usually giant, sometimes with thrombogenesis inside, which makes a portion of these aneurysms resemble brain tumors on magnetic resonance imaging (MRI) and computed tomography (CT).…”

Yüksek yerleşimli multilobüle baziller arter anevrizmasına bağlı hidrosefali

“…Basilar artery aneurysm is not very common, 5-8% of all intracranial aneurysms are located by the basilar artery bifurcation 1 . The symptoms and findings of a basilar artery aneurysm depend on the occlusion of the parent artery and perforators, rupturing of aneurysm or mass effect 2,3 . The obstructive hydrocephalus caused by the mass effect of a basilar artery aneurysm is a rare condition.…”

“…The ventriculoperitoneal (VP) shunt procedure may lead to bleeding in or widening of aneurysm. Although the endoscopic third ventriculostomy is the ideal treatment option, it has the disadvantage of technical difficulty in the presence of th hydrocephalus with basilar tip aneurysms [2][3][4] . We explain in this report how a giant multilobed ruptured aneurysm that developed in the highlocation basilar tip causing hydrocephalus was treated successfully through clipping and lamina terminalis fenestration.…”