TY - JOUR T1 - Absence of pontine perforators in vertebrobasilar dolichoectasia on ultra-high resolution cone-beam computed tomography JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 580 LP - 584 DO - 10.1136/neurintsurg-2020-016818 VL - 13 IS - 6 AU - Tomas Dobrocky AU - Eike I Piechowiak AU - Johannes Goldberg AU - Enrique Barvulsky Aleman AU - Patrick Nicholson AU - Jeremy Lynch AU - David Bervini AU - Johannes Kaesmacher AU - Ronit Agid AU - Timo Krings AU - Andreas Raabe AU - Jan Gralla AU - Vitor M Pereira AU - Pasquale Mordasini Y1 - 2021/06/01 UR - http://jnis.bmj.com/content/13/6/580.abstract N2 - Background Vertebrobasilar dolichoectasia (VBDE) is a rare type of non-saccular intracranial aneurysm, with poor natural history and limited effective treatment options. Visualizing neurovascular microanatomy in patients with VBDE has not been previously reported, but may yield insight into the pathology, and provide important information for treatment planning.Objective To carry out a retrospective analysis of ultra-high resolution cone-beam computed tomography (UHR-CBCT) in patients with fusiform basilar aneurysms, visualizing neurovascular microanatomy of the posterior circulation with a special focus on the pontine perforators.Methods UHR-CBCT was performed in seven patients (mean age 59 years; two female) with a VBDE, and in 14 control patients with unrelated conditions.Results The mean maximum diameter of the fusiform vessel segment was 28 mm (range 19–36 mm), and the mean length of the segment was 39 mm (range 15–50 mm). In all patients with VBDE, UHR-CBCT demonstrated an absence of perforating arteries in the fusiform arterial segment and a mean of 3.7 perforators arising from the unaffected vessel segment. The network of interconnected superficial circumferential pontine arteries (brainstem vasocorona) were draping around the aneurysm sac. In controls, a mean of 3.6, 2.5, and 1.2 perforators were demonstrated arising from the distal, mid-, and proximal basilar artery, respectively.Conclusions The absence of pontine perforators in the fusiform vessel segment of VBDE is counterbalanced by recruitment of collateral flow from pontine perforators arising from the unaffected segment of the basilar artery, as well as collaterals arising from the anterior inferior cerebellar artery/posterior inferior cerebellar artery and superior cerebellar artery. These alternative routes supply the superficial brainstem arteries (brainstem vasocorona) and sustain brainstem viability. Our findings might have implications for further treatment planning.Data are available upon reasonable request. Raw data of all patients included in this study can be made available upon request to the corresponding author and after clearance by the local ethics committee. ER -