Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 6, 2012
Thrombosed Giant Vertebral Artery Aneurysm
- Vertebral artery aneurysms constitute 0.5 to 3% of all intracranial aneurysms and 20% of posterior circulation aneurysms. Giant aneurysms in this location are rare.
- They can act as space-occupying lesions and lead to obstructive hydrocephalus.
- Key Diagnostic Features: Conventional CT and MRI studies demonstrate a well-defined lobulated lesion in the posterior fossa. No intrinsic flow-void associated with this lesion is seen. There is no pulsation artifact. CT angiogram can be used to evaluate the location of this lesion with respect to the vertebrobasilar circulation. A thrombosed lumen limits evaluation of this lesion on MRA studies. Also, conventional angiograms, due to pr of a thrombosed lumen, are limited in their evaluation of such aneurysms.
- DDx: Meningioma, epidermoid, lymphoma, leukemia
- Rx: Challenging and controversial; mortality rate 9.6% and morbidity rate 38%