Treatment of Ruptured Saccular Aneurysms of the Fenestrated Vertebrobasilar Junction with Balloon Remodeling Technique

Abstract

<jats:p> Fenestration of the intracranial arteries is a relatively common occurrence. This anatomic variation may predispose to aneurysm formation at certain sites. Treatment of such aneurysms is difficult as it may occlude one of the limbs of fenestration with resultant deficit. Thus, preservation of both the limbs with adequate exclusion of the aneurysm from the circulation should be the aim of any treatment. We describe a series of four cases of ruptured aneurysms arising from a fenestrated vertebrobasilar junction treated with endovascular balloon remodeling technique. </jats:p>

Vertebro-Basilar Junction Aneurysms: A Single Centre Experience and Meta-Analysis of Endovascular Treatments

“…We found 85 cases in all, described in 29 studies, most of them as reports of single cases 19,20,23,25-29,31-33,35,37,38 . VBJ fenestration was associated in more than half of the cases, 56 cases, confirming the high incidence of aneurysm in the VBJ affected by a fenestration [12][13][14]16,19,22,28,[30][31][32][34][35][36][37][38][39] . Thorough evaluation revealed a high prevalence of endovascular treatment instead of microsurgery.…”

“…Coiling with or without balloon assistance or stenting was performed in most of the cases (39 in number) stent alone or balloon remodelling in eight cases and four cases respectively [12][13][14]19,21,27-31,34-39 . In those cases, moreover, one or both limbs of VAs were sacrificed with coiling.…”

“…For this reason, different factors should be critically considered in the selection of the most appropriate treatment strategy, including: the preoperative clinical and neurological status of the patient and/or evaluation of the features of the aneurysm, its related vascular structures and the parental artery collateral circulation [1][2][3][4][5][6] . According to the literature, in the setting of a VBJ fenestration there is a greater incidence of aneurysm formation, approximately 35% 13 . Thus, when there is a vertebrobasilar junction aneurysm, an associated fenestration should be strongly suspected and as, most authors have reported, the proximal aspect of the fenestration is the most common site of aneurysm formation.…”

Fenestration of the vertebrobasilar junction detected with multidetector computed tomography angiography

“…Basilar artery fenestration occurs as a result of partial failure or incomplete fusion of the longitudinal neural arteries and regression of the bridging arteries connecting the longitudinal arteries [25]. Although fenestration at the vertebrobasilar junction is formed between the confluence of the bilateral distal VA and proximal part of the basilar artery, researchers agree that the best explanation for this morphological variation is the persistence or incomplete fusion of one of the temporary bridging arteries between the embryologic bilateral longitudinal neural arteries that form the basilar artery [7,25]. This could occur as a result of some genetic or environmental factors [25].…”

Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome

“…The frequent association of VBJ aneurysms with basilar artery fenestration also supports this hypothesis. [ 3 , 6 ] Treatment of such flow-related aneurysms can be performed by endovascular or microsurgical means. Proximity with the brainstem and abundance of perforators (supplying brainstem and cranial nerve) in the vicinity makes the microsurgical treatment of such aneurysms challenging; hence, the endovascular approach is favored over surgery.…”