Basilar Apex Aneurysm Manifesting as Third Ventricular Mass and Obstructive Hydrocephalus -Case Report-

Abstract

A 58-year-old male, with a past history of hypertensive thalamic hemorrhage 12 years before, presented with gradually exaggerating gait disturbance, memory disturbance, and urinary incontinence. On admission, he had gait disturbance represented by petit pas and anteropulsion in addition to significant recent memory disturbance. Cranial computed tomography (CT) revealed a hyperdense mass in the third ventricle with triventricular dilation. Cerebral magnetic resonance (MR) imaging and MR angiography identified the third ventricular lesion as saccular basilar apex aneurysm. No other intracranial abnormal intensity contributing to his clinical symptoms was recognized. Cervical MR angiography showed normal findings. Cerebral blood flow (CBF) measurements revealed diffuse CBF reduction in the cerebral hemisphere. The patient underwent coil embolization which accomplished complete aneurysm occlusion. He showed only slight improvement in his gait disturbance after embolization, and CT following embolization revealed persistent ventriculomegaly. Ventriculoperitoneal shunting was carried out. Intraoperative neuroendoscopy demonstrated cerebrospinal fluid (CSF) obstruction caused by the embolized aneurysm at the level of the third ventricle, with normal CSF findings. Postoperatively his gait disturbance and intellectual impairment showed remarkable improvement. Basilar apex aneurysm associated with obstructive hydrocephalus has complex underlying pathology and should be treated by a combination of definitive aneurysm obliteration and CSF diversion.

Large Aneurysm of Basilar Artery Tip Mimicking Midbrain Tumor and Causing Unilateral Obstructive Hydrocephalus: a Case Report and Technical Note

“…The literature concerned with development of obstructive hydrocephalus caused by giant/large BA tip aneurysm is scarce and only a few case report/small case series have been described so far [3][4][5][13][14][15][16] . The clinical and radiological signs, as well as the differential diagnostic considerations have been addressed 13,16 . However, there was no universal management option for this rare and delicate condition proposed.…”

Yüksek yerleşimli multilobüle baziller arter anevrizmasına bağlı hidrosefali

“…Perioperative lamina terminalis fenestration, endoscopic third ventriculostomy and VP shunt procedure are the treatment options for this complication 3,4,6 . Endovascular intervention is a widely used method as an alternative to surgery in the treatment of posterior circulation aneurysms 1,4,7 . However, clipping of aneurysms through the microsurgical method should be preferred particularly in giant aneurysms that have a mass effect.…”

Aneurysm of the distal anterior cerebral artery radiologically mimicking a ventricular mass

“…16 On the other hand, aneurysms with domes extending into the ventricle have been described in either the third or fourth ventricle in a few cases (Table 1). More specifically, aneurysms in the third ventricle arise from a major branch point of the circle of Willis, [1][2][3]5,7,[9][10][11]15,17,18,21,25,28,29,31 and lesions in the fourth ventricle arise from a distal branch of the PICA. 20,30 In the present case, we reported on a distal ACA aneurysm whose dome extended into the lateral ventricle cavity, which is the first case in the literature.…”

“…Some ventricular aneurysms, particularly those that have reached large or giant sizes, have presented with mass effect. 15,25,28 Some have occupied entire ventricular cavities of the brain, but a distal ACA aneurysm in the ventricular cavity has not been reported.…”