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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0654

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Aneurysms of the Vertebrobasilar Junction: Incidence, Clinical Presentation, and Outcome of Endovascular Treatment

J.P.P. Peluso^a, W.J. van Rooij^a, M. Sluzewski^a and G.N. Beute^b

^a Department of Radiology, St Elisabeth Ziekenhuis, Tilburg, the Netherlands
^b Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, the Netherlands

View larger version (14K): [in this window] [in a new window]   Fig 1. 52-year-old woman with good-grade SAH. A and B, 3D angiogram (A) shows a small vertebrobasilar junction aneurysm on the proximal part of a basilar fenestration and 6 months (B) later demonstrates stable complete occlusion of the aneurysm.

View larger version (21K): [in this window] [in a new window]   Fig 2. A 64-year-old man with ruptured vertebrobasilar junction aneurysm. A and B, 3D (A) and 2D (B) angiograms demonstrate a dumbbell-shaped vertebrobasilar junction aneurysm on the bridging artery of a basilar fenestration. C, After coiling is performed, complete occlusion is seen.

View larger version (51K): [in this window] [in a new window]   Fig 3. A 29-year-old man with sudden neck pain followed by right-sided muscle weakness and difficulty in swallowing. A and B, MR image (A) and frontal bilateral vertebral angiogram (B) show a giant partially thrombosed vertebrobasilar junction aneurysm compressing the brain stem. C, Bilateral frontal carotid angiogram after occluding the right vertebral artery proximal to the PICA with a balloon (arrow) and the left vertebral artery distal to the PICA with coils (double arrow). Flow to the basilar artery is reversed with outflow to the right PICA, yet the aneurysm lumen still fills. D, Lateral radiograph during coiling of the aneurysm lumen via the posterior communicating artery 2 months later. The arrow indicates deflated balloon remnant in the right vertebral artery. The double arrow indicates coils in the left vertebral artery. E–G, Six months later, a frontal view of right carotid angiogram (E) demonstrates filling of the basilar artery via the right posterior communicating artery. Frontal view of the right thyrocervical trunk (F) shows recanalization of the distal right vertebral artery with filling of the PICA territory. Frontal view of the left vertebral angiogram (G) shows filling of the left PICA territory. The aneurysm is completely occluded. H, MR imaging 2 years after presentation shows remarkable shrinkage of the aneurysm. The patient was free of symptoms.

View larger version (97K): [in this window] [in a new window]   Fig 4. 3D angiogram shows a vertebrobasilar junction aneurysm on the bridging artery of a basilar fenestration. With this anatomy, sparing the parent bridging artery would be sensible in preserving flow to the basilar artery. RV indicates right vertebral artery; LV, left vertebral artery; BA, basilar artery. (Compare with Fig 2.)