Spontaneous subarachnoid hemorrhage caused by ruptured aneurysm of basilar trunk perforator: a case report and literature review

Yao Wu, Zhaoliang Li, Dehong Yang, Tao Wu, Ailin Chen, Chungang Dai, Qing Zhu, Yao Wu, Zhaoliang Li, Dehong Yang, Tao Wu, Ailin Chen, Chungang Dai, Qing Zhu

Abstract

Background: Aneurysm of basilar perforator was rarely reported in the literature. It is difficult to treat due to its small size and deep-seated location. Excessive treatment may cause complications that resulted from ischemic events of parent perforators. Therefore, it is important to make clinical strategy for such patients to improve the prognosis.

Case presentation: One case, who presented as spontaneous subarachnoid hemorrhage, despite the negative result in computed tomography angiography firstly, was diagnosed angiographically as a ruptured aneurysm of the basilar perforator. A good clinical outcome of the case was achieved during the follow-up after conservative observation for 2 months, as well as the disappearance of previous lesion from angiography.

Conclusions: Aneurysm located at perforator of basilar trunk was rare and difficult to treat. Conservative observation for certain cases with periodic angiography follow-up was considered in order to prevent the patients from potential iatrogenic effects.

Keywords: Basilar trunk; Intracranial aneurysm; Perforator.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Imaging data of the case. A SAH surrounding potine was confirmed by head CT after onset. B Emergency CTA did not demonstrate definite source of hemorrhage. C, D Three-dimensional rotation angiography (3DRA) revealed a small aneurysm localized at posterior perforator of rostral basilar trunk. E, F The lesion disappeared from DSA during 2 months of follow-up with preservation of parent perforator
Fig. 2
Fig. 2
Simulating procedure on printed three dimension model. A Subtemporal keyhole approach of right side. The depth of aneurysm is 7 cm from temporal bone. B The length of visible basilar artery is 5 mm between petrosal apex and neck of aneurysm under the microsurgical corridor. C The aneurysm can be clipped by longer clip after retraction of isplateral superior cerebellar artery. D Relationship of clip and surrounding vascular structures after simulating clip application

References

    1. Vargas J, Walsh K, Turner R, Chaudry I, Turk A, Spiotta A. Lenticulostriate aneurysms: a case series and review of the literature. J Neurointerv Surg. 2015;7(3):194–201. doi: 10.1136/neurintsurg-2013-010969.
    1. van Gijn J, van Dongen KJ, Vermeulen M, Hijdra A. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology. 1985;35(4):493–497. doi: 10.1212/WNL.35.4.493.
    1. Park SQ, Kwon OK, Kim SH, Oh CW, Han MH. Pre-mesencephalic subarachnoid hemorrhage: rupture of tiny aneurysms of the basilar artery perforator. Acta Neurochir. 2009;151(12):1639–1646. doi: 10.1007/s00701-009-0416-0.
    1. Ghogawala Z, Shumacher JM, Ogilvy CS. Distal basilar perforator artery aneurysm: case report. Neurosurgery. 1996;39(2):393–396. doi: 10.1097/00006123-199608000-00034.
    1. Hamel W, Grzyska U, Westphal M, Kehler U. Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir. 2005;147(12):1283–1286. doi: 10.1007/s00701-005-0615-2.
    1. Fiorella D, Albuquerque FC, Deshmukh VR, Woo HH, Rasmussen PA, Masaryk TJ, McDougall CG. Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery. 2006;59(2):291–300. doi: 10.1227/01.NEU.0000223650.11954.6C.
    1. Sanchez-Mejia RO, Lawton MT. Distal aneurysms of basilar perforating and circumferential arteries. Report of three cases. J Neurosurg. 2007;107(3):654–659. doi: 10.3171/JNS-07/09/0654.
    1. Mathieson CS, Barlow P, Jenkins S, Hanzely Z. An unusual case of spontaneous subarachnoid haemorrhage - a ruptured aneurysm of a basilar perforator artery. Br J Neurosurg. 2010;24(3):291–293. doi: 10.3109/02688690903572095.
    1. Deshaies EM, Jacobsen W, Krishnamurthy S. Enterprise stent-within-stent embolization of a basilar artery perforator aneurysm. World J Neurosci. 2011;1(3):45–48. doi: 10.4236/wjns.2011.13007.
    1. Chen L, Chen E, Chotai S, Tian X. An endovascular approach to ruptured aneurysms of the circumferential branch of the basilar artery. J Clin Neurosci. 2012;19(4):527–531. doi: 10.1016/j.jocn.2011.04.049.
    1. Gross BA, Puri AS, Du R. Basilar trunk perforator artery aneurysms. Case report and literature review. Neurosurg Rev. 2013;36(1):163–168. doi: 10.1007/s10143-012-0422-1.
    1. Apok V, Tarnaris A, Brydon HL. An unusual aneurysm of a basilar perforating artery presenting with a subarachnoid haemorrhage. Br J Neurosurg. 2013;27(1):105–107. doi: 10.3109/02688697.2012.717977.
    1. Nyberg EM, Chaudry MI, Turk AS, Spiotta AM, Fiorella D, Turner RD. Report of two cases of a rare cause of subarachnoid hemorrhage including unusual presentation and an emerging and effective treatment option. J Neurointerv Surg. 2013;5(5):e30. doi: 10.1136/neurintsurg-2012-010387.
    1. Ding D, Starke RM, Jensen ME, Evans AJ, Kassell NF, Liu KC. Perforator aneurysms of the posterior circulation: case series and review of the literature. J Neurointerv Surg. 2013;5(6):546–551. doi: 10.1136/neurintsurg-2012-010557.
    1. Sivakanthan S, Carlson AP, van Loveren H, Agazzi S. Surgical clipping of a basilar perforator artery aneurysm: a case of avoiding perforator sacrifice. J Neurol Surg A Cent Eur Neurosurg. 2015;76(1):79–82. doi: 10.1055/s-0033-1356488.
    1. Chalouhi N, Jabbour P, Starke RM, Zanaty M, Tjoumakaris S, Rosenwasser RH, Gonzalez LF. Treatment of a basilar trunk perforator aneurysm with the pipeline embolization device: case report. Neurosurgery. 2014;74(6):E697–E701. doi: 10.1227/NEU.0000000000000308.
    1. Chavent A, Lefevre PH, Thouant P, Cao C, Kazemi A, Mourier K, Ricolfi F. Spontaneous resolution of perforator aneurysms of the posterior circulation. J Neurosurg. 2014;121(5):1107–1111. doi: 10.3171/2014.7.JNS132411.
    1. Kim YJ, Ko JH. Sole stenting with large cell stents for very small ruptured intracranial aneurysms. Interv Neuroradiol. 2014;20(1):45–53. doi: 10.15274/INR-2014-10007.
    1. Daruwalla VJ, Syed FH, Elmokadem AH, Hurley MC, Shaibani A, Ansari SA. Large basilar perforator pseudoaneurysm: A case report. Interv Neuroradiol. 2016;22(6):662–665. doi: 10.1177/1591019916659261.
    1. Peschillo S, Caporlinqua A, Cannizzaro D, et al. Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms. J Neurointerv Surg. 2016;8(2):190–196. doi: 10.1136/neurintsurg-2014-011511.
    1. Forbrig R, Eckert B, Ertl L, Patzig M, Brem C, Vollmar C, Röther J, Thon N, Brückmann H, Fesl G. Ruptured basilar artery perforator aneurysms--treatment regimen and long-term follow-up in eight cases. Neuroradiology. 2016;58(3):285–291. doi: 10.1007/s00234-015-1634-1.
    1. Satti SR, Vance AZ, Fowler D, Farmah AV, Sivapatham T. Basilar artery perforator aneurysms (BAPAs): review of the literature and classification. J Neurointerv Surg. 2017;9(7):669–673. doi: 10.1136/neurintsurg-2016-012407.
    1. Aboukais R, Zairi F, Estrade L, Quidet M, Leclerc X, Lejeune JP. A dissecting aneurysm of a basilar perforating artery. Neurochirurgie. 2016;62(5):263–265. doi: 10.1016/j.neuchi.2016.03.003.
    1. Jiang Y, Luo J, Zheng J, Li Y. Endovascular pure electrocoagulation of intracranial perforator blister-like aneurysm not accessible to microcatheter-New approach to treat small vessel hemorrhage disease. Int J Stroke. 2016;11(5):NP60–NP61. doi: 10.1177/1747493016641953.
    1. Finitsis S, Derelle AL, Tonnelet R, Anxionnat R, Bracard S. Basilar perforator aneurysms: presentation of 4 cases and review of the literature. World Neurosurg. 2017;97:366–373. doi: 10.1016/j.wneu.2016.10.038.
    1. Buell TJ, Ding D, Raper DMS, Chen CJ, Hixson HR, Crowley RW, Evans AJ, Jensen ME, Liu KC. Posterior circulation perforator aneurysms: a proposed management algorithm. J Neurointerv Surg. 2018;10(1):55–59. doi: 10.1136/neurintsurg-2016-012891.
    1. Chau Y, Sachet M, Sédat J. Should we treat aneurysms in perforator arteries from the basilar trunk? Review of 49 cases published in the literature and presentation of three personal cases. Interv Neuroradiol. 2018;24(1):22–28. doi: 10.1177/1591019917734531.
    1. Elsheikh S, Möhlenbruch M, Seker F, et al. Flow diverter treatment of ruptured basilar artery perforator aneurysms: a multicenter experience [published online ahead of print, 2022 Jan 20]. Clin Neuroradiol. 2022. 10.1007/s00062-021-01133-y.
    1. Finitsis S, Derelle AL, Tonnelet R, Anxionnat R, Bracard S. Basilar perforator aneurysms: presentation of 4 cases and review of the literature. World Neurosurg. 2017;97:366–373. doi: 10.1016/j.wneu.2016.10.038.
    1. Lan Q, Chen A, Zhang T, Li G, Zhu Q, Fan X, Ma C, Xu T. Development of three-dimensional printed craniocerebral models for simulated neurosurgery. World Neurosurg. 2016;91:434–442. doi: 10.1016/j.wneu.2016.04.069.
    1. Marinković SV, Gibo H. The surgical anatomy of the perforating branches of the basilar artery. Neurosurgery. 1993;33(1):80–87.
    1. Cantón G, Levy DI, Lasheras JC, Nelson PK. Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms. J Neurosurg. 2005;103(5):891–902. doi: 10.3171/jns.2005.103.5.0891.
    1. Phillips TJ, Wenderoth JD, Phatouros CC, Rice H, Singh TP, Devilliers L, Wycoco V, Meckel S, McAuliffe W. Safety of the pipeline embolization device in treatment of posterior circulation aneurysms. AJNR Am J Neuroradiol. 2012;33(7):1225–1231. doi: 10.3174/ajnr.A3166.
    1. Ma H, Zhao R, Fang Y, Li Q, Yang P, Huang Q, Xu Y, Hong B, Liu JM. Endovascular electrothrombosis: a promising alternative for basilar artery perforator aneurysm treatment. Interv Neuroradiol. 2021;27(4):511–515. doi: 10.1177/1591019920987913.

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