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

Brian A. O'Shaughnessy, Christopher C. Getch, Bernard Bendok, Richard J. Parkinson, H. Hunt Batjer, Michael T. Lawton, Daniel L. Barrow, Christopher S. Ogilvy

Research output: Contribution to journalArticle

23 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1223
Number of pages1
Issue number5
StatePublished - Nov 2004
Externally publishedYes


ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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