Progressive growth of a giant dolichoectatic vertebrobasilar artery aneurysm after complete Hunterian occlusion of the posterior circulation: case report

Neurosurgery. 2004 Nov;55(5):1223. doi: 10.1227/01.neu.0000140990.91277.85.


Objective and importance: Dolichoectatic vertebrobasilar artery aneurysms are often extremely difficult, if not impossible, to treat with microneurosurgical clip reconstruction. As such, a Hunterian strategy via vertebral or basilar artery sacrifice is often used. We have encountered a patient in whom deliberate bilateral vertebral artery sacrifice was insufficient to avoid progressive expansion of a giant dolichoectatic vertebrobasilar artery aneurysm. On the basis of a review of the literature, we are unaware of another reported case.

Clinical presentation: A 60-year-old man presented with signs and symptoms of brainstem compression from a large fusiform aneurysm involving the distal dominant vertebral and proximal basilar arteries. Results of angiographic evaluation were highly characteristic of underlying dolichoectasia.

Intervention: The patient was treated initially with staged bilateral vertebral artery occlusion and adjunctive posterior circulation revascularization. After this therapy failed, he underwent a trapping procedure and aneurysm deflation.

Conclusion: Unclippable aneurysms of the vertebrobasilar system are formidable lesions. They are not uniformly treatable by direct surgical reconstruction, and their growth is not consistently stabilized by the implementation of a complete Hunterian strategy. Future developments related to the use of endovascular stent technology may offer a more successful treatment approach for patients with these complex cerebrovascular lesions.

Publication types

  • Case Reports

MeSH terms

  • Basilar Artery / surgery*
  • Cerebrovascular Circulation / physiology*
  • Constriction, Pathologic / surgery*
  • Decompression, Surgical / adverse effects
  • Decompression, Surgical / methods
  • Humans
  • Intracranial Aneurysm / surgery*
  • Male
  • Microsurgery / adverse effects*
  • Microsurgery / methods*
  • Middle Aged
  • Neurosurgery / methods*
  • Treatment Failure
  • Vertebral Artery / surgery*
  • Vertebrobasilar Insufficiency / surgery*