TY - JOUR T1 - 3D Computational Fluid Dynamics of a Treated Vertebrobasilar Giant Aneurysm: A Multistage Analysis JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1387 LP - 1394 DO - 10.3174/ajnr.A3373 VL - 34 IS - 7 AU - F. Graziano AU - V.M. Russo AU - W. Wang AU - D. Khismatullin AU - A.J. Ulm III Y1 - 2013/07/01 UR - http://www.ajnr.org/content/34/7/1387.abstract N2 - BACKGROUND AND PURPOSE: The treatment of giant aneurysms of the vertebrobasilar junction remains a challenging task in neurosurgical practice, and the reference standard therapy is still under debate. Through a detailed postmortem study, we analyzed the hemodynamic factors underlying the formation and recanalization of an aneurysm located at this particular site and its anatomic configuration. METHODS: An adult fixed cadaveric specimen with a known VBJ GA, characterized radiographically and treated with endovascular embolization, was studied. 3D computational fluid dynamic models were built based on the specific angioarchitecture of the specimen, and each step of the endovascular treatment was simulated. RESULTS: The 3D CFD study showed an area of hemodynamic stress (high wall shear stress, high static pressure, high flow velocity) at the neck region of the aneurysm, matching the site of recanalization seen during the treatment period. CONCLUSIONS: Aneurysm morphologic features, location, and patient-specific angioarchitecture are the principal factors to be considered in the management of VBJ giant aneurysms. The 3D CFD study has suggested that, in the treatment of giant aneurysms, the intra-aneurysmal environment induced by partial coil or Onyx embolization may lead to hemodynamic stress at the neck region, potentially favoring recanalization of the aneurysm. CFDcomputational fluid dynamicsGAgiant aneurysmVAvertebral arteryVBJvertebrobasilar junctionWSSwall shear stress ER -