Spontaneous resolution of perforator aneurysms of the posterior circulation

Abstract

Key Words • vertebrobasilar • perforator artery • aneurysm • negative angiogram • vascular disordersAbbreviations used in this paper: mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies.

Nontraumatic, posterior circulation pseudoaneurysm of the basilar artery summit with complete spontaneous resolution: Case report and literature review

“…Moreover, spontaneous resolution of basilar artery perforator aneurysms has also been reported suggesting that aneurysms in the posterior circulation, possibly due to different flow patterns, may possibly undergo spontaneous resolution more frequently. [6] Similar to the present case, spontaneous occlusion of a traumatic pericallosal pseudoaneurysm was seen 14 days after the first angiography. [22] Furthermore, the histopathology of cadaveric pseudoaneurysms was shown to exhibit smooth muscle cell proliferation, macrophage accumulation, and lymphocytic infiltration around the injury site in vessel wall 7 days after SAH, which point to continuous remodeling process.…”

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

“…The remaining 31 studies were assessed in full text and, after revision of cross references, 24 retrospective case series met our predefined inclusion criteria and were included in the evidence synthesis. Of the 24 included articles, 19 (79%) had a low risk of bias,2–4 8–23 three (12%) had a medium risk of bias,24–26 and two (8%) had a high risk of bias27 28 (see online supplementary table 1).…”

“…Of the nine patients with suboptimal occlusion, only five underwent an active second treatment (two clipping,9 25 one wrapping,18 two stenting3 16), three of which had an mRS 0–2 in the final follow-up. The remaining 4/9 (44.4%) patients were managed conservatively after the first attempt 8 13 21…”

“…Multiple interventions and staged approaches may also be expected when treating non-trunk BAPAs. Every time a first treatment attempt was unsuccessful, mostly due to failure to place a coil, a second treatment was not attempted, especially in those cases where the initial maximum aneurysm diameter was <2.5 mm, which raises questions about the indication and benefit of any active treatment in this subgroup of patients 8 9 13 18 25. This review demonstrated that up to 24% of patients had a suboptimal occlusion rate after an initial treatment attempt; however, 66% of those had a favorable mRS score at final follow-up.…”

Spontaneous Subarachnoid Hemorrhage Caused by Ruptured Aneurysm of Basilar Trunk Perforator

“…Although the cases reported so far are all caused by SAH, there are no reports of unruptured cases, so the natural history of BAPA is not clear [26].Because of the small size of the aneurysm,it is di cult to complete superselective artery embolization Because of the small size of the aneurysm, On the other hand,The aneurysm is located at the deep end, which makes it di cult to expose.Ischemic events caused by di culties in perforating perforating branches are all problems to be considered when choosing a treatment plan.However,some cases were found to be self-healing during follow-up, so conservative observation under DSA follow-up was the preferred method in many reports [16].Rehaemorrhage occurred in 6 of the 21 conservative cases reported in the literature (28.57%), of which 2 received microsurgery and 2 received endovascular intervention. (1 cases were treated with coil embolization, and 1 case were implanted with ow diverter).2 cases remained conservative.Of the 4 patients receiving intervention, only 1 recovered well, and the other 3 had neurological dysfunction of varying degrees due to perforator ischemic events.2 patients who received conservative treatment recovered well.This result proves that the effect of active intervention may not be better than conservative observation [5,6,11,20,24].…”