Lenticulostriate aneurysms: a case series and review of the literature

Abstract

LSA aneurysms are rare entities that present several treatment challenges. We have summarized the cumulative experience with these lesions and proposed a classification scheme that has treatment implications.

Basilar artery perforator aneurysms (BAPAs): review of the literature and classification

“…The largest and most recent case review by Vargas et al 1 analyzed 48 reported cases of lenticulostriate perforator aneurysms. There is, however, minimal published literature on the natural history, classification, and recommended treatment of BAPAs.…”

“…A classification scheme for lenticulostriate aneurysms based on their relationship with the parent vessel and perforating arteries was described by Maeda et al in 200112 and re-described by Vargas et al in 2015 1. Whether classification systems alter management or outcome has yet to be determined, but they provide a means to consistently describe these aneurysms and serve as a framework for future studies.…”

“…Despite our goal of minimizing metal coverage over perforators, the patient still had a left pontine perforator infarction, which might have been related to the perforator associated with the BAPA. There may be natural anastomoses between adjacent perforating arteries which may potentially provide collateral flow if a vessel is sacrificed, with the exception of thalomoperforating arteries of the basilar apex 1. The recent case series by Peschillo et al describes three cases of BAPA treated with Pipeline flow diversion therapy in patients with SAH.…”

Flow diverter stents for unruptured saccular anterior circulation perforating artery aneurysms: safety, efficacy, and short-term follow-up

“…AChA aneurysms comprise 2–5% of the intracranial aneurysms,12 13 and fewer than 60 cases of true LSA aneurysms have been reported 14 15. Owing to the small number of angiographically detected LSA aneurysms, the natural history of these aneurysms is unclear 16–18…”

“…Despite the small size of such aneurysms, rupture results in a poor outcome, and thus treatment of incidentally detected aneurysms is reasonable 22. Most reported LSA aneurysms have been treated by craniotomy and clipping, and this certainly is an option for these lesions depending on the anatomy, with a small risk of perforator infarction (reviewed by Vargas et al 15). Catheterization and coiling of these small aneurysms carries a risk of intraoperative aneurysm rupture and of thromboembolic occlusion of the perforator arteries, especially at the neck of the aneurysm, from where these vessels usually arise.…”