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Hemorrhagic stroke
Review
Management of basilar fenestration aneurysms: a systematic review with an illustrative case report
  1. Muhammed Amir Essibayi1,
  2. Visish M Srinivasan1,
  3. Humberto José Madriñán-Navia1,2,
  4. Marian T Park1,
  5. Lea Scherschinski1,
  6. Joshua S Catapano1,
  7. Emmajane G Rhodenhiser1,
  8. Christopher S Graffeo1,
  9. Andrew F Ducruet1,
  10. Felipe C Albuquerque1,
  11. Michael T Lawton1
  1. 1Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
  2. 2Department of Neurosurgery, Center for Research and Training in Neurosurgery, Hospital Universitario de la Samaritana, Bogotá, Colombia
  1. Correspondence to Dr Michael T Lawton, Barrow Neurological Institute, Phoenix, AZ 85013, USA; neuropub{at}barrowneuro.org

Abstract

Background Basilar artery (BA) fenestration aneurysm (BAFA) is a rare phenomenon commonly accompanying other aneurysms. Treatment is challenging, and few cases have been reported. This review investigated the management outcomes of BAFAs.

Methods Publication databases were searched to identify studies evaluating outcomes of endovascular treatment (EVT) and microsurgical treatment of BAFAs from inception through 2021. Outcomes (clinical, angiographic, postoperative complications, and retreatment rates) were collected and analyzed. The authors present their case of a patient treated for a BAFA.

Results Including the authors’ case, 184 patients with 209 BAFAs were reported in 68 studies. Most patients (130/175; 74.3%) presented with ruptured aneurysms, most commonly involving the proximal segment of the BA. Most BAFAs were small (52/103, 50.5%) and saccular (119/143, 83.2%). Most patients underwent EVT (143/184, 77.7%); the rest underwent microsurgery. Postoperative complications after EVT occurred in 10 (8.3%) of 120 patients, with 4 of the 10 experiencing strokes. At clinical follow-up, most EVT patients (74/86, 86.0%) showed good outcomes; 3.9% (2/51) had died. Most aneurysms managed with EVT (56/73, 76.7%) showed complete occlusion at follow-up; 7.3% (8/109) were retreated. Postoperative complications occurred in 62.2% (23/37) of microsurgical patients; 5 (21.7%) of the 23 experienced strokes. All patients showed good clinical outcomes at follow-up. Most aneurysms (22/28, 78.6%) treated microsurgically showed complete occlusion at angiographic follow-up, with no retreatment required.

Conclusion BAFAs are often symptomatic; thus, treatment is challenging. By the 2000s, treatment had moved from microsurgical to endovascular modalities, with good clinical and angiographic outcomes.

  • Aneurysm
  • Flow Diverter
  • Intervention

https://doi.org/10.1136/jnis-2022-019728

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    Footnotes

    • Twitter @97amer, @vishishs, @Graffeo, @ducruetaf, @fcalbuquerque51, @mtlawton

    • MAE and VMS contributed equally.

    • Contributors MAE and VMS researched the literature and conceived the study. MAE, HJM-N, and ER collected the data. MAE analyzed the data. MAE, VMS, HJM-N, MTP, and LS wrote the first draft of the manuscript. All authors (MAE, VMS, HJM-N, MTP, LS, JSC, ER, CSG, AFD, FCA, and MTL) reviewed and edited the manuscript and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests FCA and AFD are on the editorial board for Journal of NeuroInterventional Surgery. No prior submissions or presentations.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.