Treatment of a Giant Fusiform Basilar Aneurysm with Partial Intra-Aneurysmal Embolization Combined with Mid-Basilar Artery Occlusion in a Child

Excerpt

Intracranial aneurysms are rare in the pediatric population, defined as patients 18-year-old or younger, with a reported prevalence ranging from 0.5 to 4.6 % [1‐5]. Recent studies demonstrate that 17–27 % of these aneurysms are on the posterior circulation and 20–45 % are giant [6‐8]. Aneurysms of the basilar artery (BA) trunk pose difficult therapeutic challenges. In the neurosurgical literature, these aneurysms are poor regarding their natural history and outcome, as they are associated with 80 % mortality [9]. Different complex skull base approaches have been attempted to access the basilar trunk area using several techniques like temporary balloon occlusion [10] or even with the aid of hypothermic cardiac arrest [11]. This has prompted the neurointerventional endovascular approaches to treat posterior circulation aneurysms. Recent reports have documented successful results using electrolytically detachable coils with or without assisted balloon or stent techniques in the treatment of many posterior circulation aneurysms [12‐15]. Selective occlusion of the aneurysmal sac is the choice. However, there are some cases where selective aneurysm obliteration by either surgical clipping or endovascular approach is impossible or associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is giant or has a large neck or involves an eloquent perforator area like BA trunk area [16‐18]. In such cases, additional parent vessel occlusion at the level of aneurysmal neck may be another alternative. We present the case of a 10-year-old boy with hemiparesis and multiple cranial nerves paralysis due to severe brainstem compression by a large and growing fusiform basilar aneurysm, who was treated successfully with partial intra-aneurysmal embolization combined with mid-BA occlusion by endovascular techniques. …