Endovascular Management of Complex Fenestration-Associated Aneurysms: A Single-Institution Retrospective Study and Review of Existing Techniques

Schmidt, Richard F.; Sweid, Ahmad; Chalouhi, Nohra; Avery, Michael B; Sajja, Kalyan; Al-Saiegh, Fadi; Weinberg, Joshua; Asada, Ashlee; Joffe, Daniel; Zarzour, Hekmat; Gooch, M. Reid; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula

doi:10.1016/j.wneu.2020.10.131

Cited by 8 publications

(6 citation statements)

References 30 publications

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“…Managing any ruptured aneurysm requires multidisciplinary discussion to evaluate both surgical and endovascular interventions, which can present speci c challenges in vertebral arterial anomalies 37 .…”

Section: Discussionmentioning

confidence: 99%

Paediatric subarachnoid haemorrhage and severe vasospasm secondary to traumatic pseudoaneurysm of a fenestrated vertebral artery: A case report and review of the literature

Kameda-Smith

James

Rennie

et al. 2022

Preprint

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Paediatric intracranial aneurysms are rare entities accounting for less than 5% of all age intracranial aneurysms. Traumatic aneurysms are more common in children and have an association with anatomical variations such as arterial fenestrations. Here we present a case of a child initially presenting with traumatic subarachnoid haemorrhage who returned to baseline and was discharged home only to return within 2 weeks with diffuse subarachnoid and intraventricular re-haemorrhage. A dissecting aneurysm of a duplicated (fenestrated) V4 vertebral artery segment was identified as a rare cause of rebleeding. We describe a course complicated by severe vasospasm delaying aneurysm detection and treatment. Dissecting aneurysms in children should be considered in all cases of delayed post-traumatic cranial rebleeding, particularly where there is anomalous arterial anatomy.

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Section: Discussionmentioning

confidence: 99%

Paediatric subarachnoid haemorrhage and severe vasospasm secondary to traumatic pseudoaneurysm of a fenestrated vertebral artery: A case report and review of the literature

Kameda-Smith

James

Rennie

et al. 2022

Preprint

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“…Lorenzo Rinaldo, MD, PhD, 1 Soliman Oushy, MD, 1 and Giuseppe Lanzino, MD 1,2 Departments of 1 Neurosurgery and 2 Radiology, Mayo Clinic, Rochester, Minnesota Aneurysms associated with a vertebrobasilar fenestration are rare lesions and can grow to a giant size, presenting significant therapeutic challenges. Endovascular treatment of these aneurysms has traditionally been with coiling; however, flow diverter placement within the fenestration arms has recently proven to be a viable treatment strategy.…”

Section: Combined Deconstructive and Reconstructive Treatment Of A Gi...mentioning

confidence: 99%

“…Vertebrobasilar fenestration aneurysms are very rare, and thus standardized treatment strategies are lacking. Flow diverter placement within the fenestration arms with or without coiling of the aneurysm sac has been shown to be effective in a small case series, 1 and this was our favored strategy. Alternative strategies include coiling with or without stent placement within the fenestration arms, which has also been shown to be successful in case reports and small case series.…”

Section: Transcriptmentioning

confidence: 99%

Combined deconstructive and reconstructive treatment of a giant vertebrobasilar fenestration aneurysm

Rinaldo¹,

Oushy²,

Lanzino

2022

Neurosurgical Focus: Video

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Aneurysms associated with a vertebrobasilar fenestration are rare lesions and can grow to a giant size, presenting significant therapeutic challenges. Endovascular treatment of these aneurysms has traditionally been with coiling; however, flow diverter placement within the fenestration arms has recently proven to be a viable treatment strategy. The authors present a case of a giant vertebrobasilar fenestration aneurysm in a patient presenting with a cranial nerve VI palsy. The lesion was treated by using a combination of flow diverter placement and vertebral artery sacrifice. The nuances of flow diversion therapy for these aneurysms and the management of intra- and postoperative complications are discussed. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2256

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“…Fenestration of the basilar artery (BA) is a result of a segmental nonjunction of the primitive dorsal neural arteries, 1 and this artery is the second-most common site for intracranial arterial fenestration after the anterior communicating artery. 2 Aneurysms involving fenestrations 3,4 are well described. Basilar artery fenestration aneurysms (BAFAs) often arise from the proximal end of the fenestration limbs, sometimes from one or both fenestration limbs, and may also incorporate the vertebral arteries.…”

mentioning

confidence: 99%

“…5 BAFAs comprise 0.33% of all intracranial aneurysms 6 and as many as 7% of all BA aneurysms. 1 These aneurysms have a high rate of rupture, 4,7 and small BAFAs are often treated because of hemodynamic and structural factors. 6 Because of the interesting course of these vessels and variant projections, treating BAFAs is more complex than treating aneurysms in more common locations.…”

mentioning

confidence: 99%

Endovascular Embolization of Basilar Artery Fenestration Aneurysms: A 21-Year Institutional Case Series

Srinivasan,

Singh,

Karahalios

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Basilar artery fenestration is a rare phenomenon sometimes associated with basilar artery fenestration aneurysms (BAFAs). This review investigates the natural history and management outcomes of BAFAs and describes the outcomes of BAFAs treated with embolization. METHODS: A single-center database was queried for all cases of endovascular BAFA treatment. Data on complications, clinical and angiographic outcomes, and retreatment rates were collected. RESULTS: Seventeen aneurysms across 17 patients were treated. The mean (SD) age was 56 (13) years, and 15 (88%) patients were women. Among 15 aneurysms with data available, 2 arose from the fenestration limbs and 13 from both limbs and the vertebral artery. Of 16 aneurysmal projections available, 7 projected anteriorly, 7 posteriorly, and 2 superiorly. Among 17 patients, balloon-assisted coiling was the most common treatment (n = 10), followed by primary coiling (n = 3), stent-assisted coiling (n = 2), coiling with flow diversion (n = 1), and balloon-assisted coiling and flow diversion (n = 1). Complications noted in 5 patients included hemorrhage, thromboembolism, paresthesias, vasospasm, and transient hemiparesis. Among 16 patients with postoperative results available, 12 showed favorable clinical outcomes, 3 were disabled, and 1 died. The rates of postoperative complete (Raymond–Roy Occlusion Classification 1) and incomplete (Raymond–Roy Occlusion Classification 2 and 3) occlusion among 15 patients with available data were 6 and 9, respectively. CONCLUSION: Endovascular management of these rare aneurysms is feasible and safe, with high rates of favorable radiographic and clinical outcomes. This series reflects a general preference toward coiling and stent-assisted coiling, although flow diversion may be considered in select cases.

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Endovascular Management of Complex Fenestration-Associated Aneurysms: A Single-Institution Retrospective Study and Review of Existing Techniques

Cited by 8 publications

References 30 publications

Paediatric subarachnoid haemorrhage and severe vasospasm secondary to traumatic pseudoaneurysm of a fenestrated vertebral artery: A case report and review of the literature

Paediatric subarachnoid haemorrhage and severe vasospasm secondary to traumatic pseudoaneurysm of a fenestrated vertebral artery: A case report and review of the literature

Combined deconstructive and reconstructive treatment of a giant vertebrobasilar fenestration aneurysm

Endovascular Embolization of Basilar Artery Fenestration Aneurysms: A 21-Year Institutional Case Series

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