Traumatic basilar pseudoaneurysm with a basilar-cavernous arteriovenous fistula

Abstract

A traumatic pseudoaneurysm of the basilar artery with a basilar-cavernous sinus arteriovenous fistula was diagnosed in a 12-year-old girl using CT, MRI and angiography. It was successfully treated by coil embolisation. We speculate on the mode of formation of this rare traumatic lesion.

Basilar artery pseudoaneurysm presenting at 5-month follow-up after traumatic atlanto-occipital dislocation in a 7-year-old girl treated with intracranial stent placement and coiling

“…5 There is one case report of a traumatic basilar pseudoaneurysm without an associated skull fracture. 6 In that case, there was immediate development of a pseudoaneurysm ( post-trauma day 1), unlike our patient who was found to have a pseudoaneurysm 5 months after the trauma. The authors postulated that acceleration-deceleration caused shearing of the basilar artery or compression of it against the clivus, which damaged the arterial wall.…”

“…The authors postulated that acceleration-deceleration caused shearing of the basilar artery or compression of it against the clivus, which damaged the arterial wall. 6 We believe that this is a likely mechanism for the formation of pseudoaneurysm in our case as well. The traumatic forces that caused dissociation of the occiput from the spine probably placed significant shear stress on the basilar artery, thus tearing the layers of the vessel wall and forming a pseudoaneurysm.…”

Basilar artery pseudoaneurysm presenting at 5-month follow-up after traumatic atlanto-occipital dislocation in a 7-year-old girl treated with intracranial stent placement and coiling

“…It is often the result of penetrating trauma4 or adjacent fracture 5. There is one case report of a traumatic basilar pseudoaneurysm without an associated skull fracture 6. In that case, there was immediate development of a pseudoaneurysm (post-trauma day 1), unlike our patient who was found to have a pseudoaneurysm 5 months after the trauma.…”

“…In that case, there was immediate development of a pseudoaneurysm (post-trauma day 1), unlike our patient who was found to have a pseudoaneurysm 5 months after the trauma. The authors postulated that acceleration-deceleration caused shearing of the basilar artery or compression of it against the clivus, which damaged the arterial wall 6. We believe that this is a likely mechanism for the formation of pseudoaneurysm in our case as well.…”

Acute formation of a pseudoaneurysm adjacent to a previously clipped anterior communicating artery aneurysm

“…Idiopathic cases may very rarely occur in children. [10] Pseudoaneurysms of the internal carotid artery (most common),[5152831] middle cerebral artery or its branches,[3202123] anterior cerebral artery or its branches,[1111516242831] anterior communicating artery (ACoA),[222631] posterior cerebral artery,[25] posterior inferior cerebellar artery,[414] superior cerebellar artery,[919] middle meningeal artery,[818262730] basilar artery,[6] and vertebral artery[1317] have been described.…”