Treatment of a basilar trunk perforator aneurysm with the pipeline embolization device: Case report

Nohra Chalouhi, Pascal Jabbour, Robert M. Starke, Mario Zanaty, Stavropoula Tjoumakaris, Robert H. Rosenwasser, L. Fernando Gonzalez

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

BACKGROUND AND IMPORTANCE: Basilar trunk perforator (BTP) aneurysms are rare lesions that pose significant challenges to microsurgical clipping and endovascular coiling. We present the intriguing case of a ruptured BTP aneurysm that was successfully treated with the Pipeline Embolization Device (PED). CLINICAL PRESENTATION: An elderly woman presenting with subarachnoid hemorrhage was found to have a 1.5-mm aneurysm arising from the proximal portion of a thin midbasilar perforator. The decision was made to treat this aneurysm with flow diversion in an attempt to preserve the patency of the perforator and to avoid the hazards associated with parent vessel trapping. A3-12-mm PED was successfully deployed in the basilar trunk across the neck of the aneurysm, causing stasis in the aneurysm, with continuous flow through the parent vessel. The procedure and postoperative course were uneventful. A follow-up angiogram 2 weeks later showed complete disappearance of the aneurysm with preservation of the patency of the perforator. At the 6-month follow-up, the patient was asymptomatic and remained neurologically intact. CONCLUSION: We present the first case of a BTP aneurysm treated with the PED. The aneurysm was successfully occluded, and the patency of the feeding vessel was preserved. In light of the limitations of coiling and the hazards associated with microsurgery and parent vessel trapping, the PED may be a valuable option for BTP aneurysms.

Original languageEnglish (US)
Pages (from-to)E697-E701
JournalNeurosurgery
Volume74
Issue number6
DOIs
StatePublished - Jun 2014
Externally publishedYes

Keywords

  • Aneurysm
  • Basilar perforator
  • Flow diversion
  • Pipeline Embolization Device

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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