Ruptured saccular aneurysm of distal vertebral artery fenestration managed with Guglielmi detachable coils and intraventricular tissue plasminogen activator. Surg Neurol 2005 Mar;63(3):244-8; discussion 248
Date
03/01/2005Pubmed ID
15734513DOI
10.1016/j.surneu.2004.02.038Scopus ID
2-s2.0-14044276821 (requires institutional sign-in at Scopus site) 22 CitationsAbstract
BACKGROUND: Aneurysms associated with vertebrobasilar fenestrations are uncommon. We report on an unusual presentation of such aneurysm with a dedicated arterial pedicle, manifesting with significant intraventricular hemorrhage. Equally important, the aneurysm was managed in a multidisciplinary fashion, which, we think, greatly contributed to a good outcome.
CASE DESCRIPTION: A 55-year-old man presented in good condition after subarachnoid and massive intraventricular hemorrhage. The aneurysm location and the extent of intraventricular hemorrhage both presented concerns regarding treatment approach. The aneurysm was first treated with transarterial coil obliteration, and intraventricular tissue plasminogen activator (tPA) infusion was given, with rapid resolution of evolving hydrocephalus. The patient had an excellent outcome.
CONCLUSION: To our knowledge, this is the first report of a vertebrobasilar fenestration saccular aneurysm with a dedicated pedicle projecting toward the foramen of Magendie with significant intraventricular hemorrhage. In addition, this patient was successfully managed with endovascular obliteration and intraventricular tPA infusion.
Author List
Kubo M, Hacein-Bey L, Varelas PN, Ulmer JL, Lemke DM, Cusick JFAuthor
Joseph F. Cusick MD Adjunct Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Aneurysm, RupturedCerebral Angiography
Fourth Ventricle
Humans
Hydrocephalus
Injections, Intraventricular
Intracranial Aneurysm
Male
Middle Aged
Neurosurgical Procedures
Postoperative Complications
Prostheses and Implants
Subarachnoid Hemorrhage
Tissue Plasminogen Activator
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures
Vertebral Artery
