In the article we showed the patient, a woman with unruptured giant aneurysm of basilar artery, we showed the done
examinations, and therapy dilemmas about what to do in the given case. We found in literature a number of examples
which suggest operation treatment, but of embolisation too, some suggest conservative treatment

Gordana Lojen

Lidija Šapina

Željka Janjetović

Željka Vuković-Arar

English

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Coll. Antropol. 35 (2011) 2: 607–609Case reportGiant Aneurysm of Basilar ArteryLidija [apina1, Gordana Lojen1, @eljka Janjetovi}2 and @eljka Vukovi}-Arar21 »Dr. Josip Ben~evi}« General Hospital, Department of Neurology, Slavonski Brod, Croatia2 »Dr. Josip Ben~evi}« General Hospital, Department of Ophtalmology, Slavonski Brod, CroatiaA B S T R A C TIn the article we showed the patient, a woman with unruptured giant aneurysm of basilar artery, we showed the doneexaminations, and therapy dilemmas about what to do in the given case. We found in literature a number of exampleswhich suggest operation treatment, but of embolisation too, some suggest conservative treatment.Key words: aneurysm, basilar artery, treatment, therapy dilemmasIntroductionIntracranial aneurysms are vascular abnormalitieswhich ruptures presents subarachnoid bleeding. It hap-pens in the age from 35–65 years, and mostly between 55and 60 years, 60% of ruptured aneurysm are found inwomen.Giant aneurysms are defined as those wich diameteris 25 mm or bigger, 60% are in anterior, 40% are in poste-rior circulation with predilecty in vertebrobasilar arthe-ries. Aneurysms originate as effect of prolonged hemody-namic stress, with important role of relationships ofanatomic locality, hemodynamics and degenerative fac-tors. Physical excertions and emotional stress are precour-sors of rupture1.Unhemorrhagical symptoms and the signs of unrup-tured aneurysms are manifested as »mass effect«, throm-bosis, embolisation, epileptical attacks, irritation of menings.Diagnosis is stated trough neuroradiological treat-ment: computed tomography (CT), multi slice-computed--tomography of brain (MSCT), multi-slice angiography(MSCT angiography), magnetic angiography (MRA), ce-rebral angiography-digital subtraction angiography (DSA).Cerebral angiography is »gold standard« for diagnos-tic and aneurysm evaluation1. Most of aneurysms ofbrain arteries with the locality in anterior circulation istreated by titan »clips«, in posterior circulation with»coil« from platinum (Guglielmi), wich is since 1995aknowledged by FDA as sure and effective method oftreatment, made better by biological active material onthe surface polyglicol/polylactat acid which coveres plati-num and decreases the risk from aneurysm recanali-sation2–6.Case ReportThe 63-years-old woman was accepted to the Depart-ment of Neurology because of fast lost of sight on botheyes, dull headache in occipital region, afterwards nau-sea and vomiting. She did not lost consciousness and de-nied head trauma. Anamnestic: she is hypertonic formany years, at acdeptance a very high value of bloodpressure. Neurologic state at acceptance: very slowly,asymmetry of the lower part of the face-skin deep left na-solabial furrow, during examination weakened sight onboth eyes, sees only shadows, somatic hypertensive.The following examinations performed:• CT of the brain: Nativ and with aplication of contrastmedium: on both sides occipital-encephalomalatia, andnew ischaemical lesion right, suprasellar right roundhyperdensal creation which was after aplication of thecontrast medium specifically opacific and which initi-ated aneurysm.• Pancerebral angiography: Giant aneurysm of basilarartery- on the right contour medium third part of basi-lar artery of wide neck. Dilatated typ of atherosclerosis.607Received for publication August 28, 2009• MSCT angiography: in the area of medium part of bas-ilar artery we see saccular aneurysm with the begin-ning on the right lateral wall with direction cranial inthe lenght 25 mm, dolychoectasy of basilar artery aswell as carotid arteries-ACI (Figure 1).• We consulted: neurosurgeon who did not recomend op-eration for the reason of the Size and statement of an-eurysm, and risk conditions, and neuroradiologist whotries to perform endovascular intervention. Tried em-bolisation was not succesfull, and for that reason con-servative treatment was continued. During hospitaltreatment with antihypertensive and antiagregationtherapy, blood pressure was normal value, laboratoryparameters were normal. After 4–5 weeks patient hada great headache of pulsatile character, with promptdisturabance of consciousness to deep coma. There wasa doubt of rupture of existed aneurysm. CT of thebrain showed great unruptured aneurysm of basilarartery and great recent ischaemic lesion of cerebellumand brain trunk and brain parenchym parietooccipitalleft, in the area of thalamus, with compression od III andIV ventricle which caused by edema. She died after 24hours. Autopsy was not done (family overload).DiscussionThe clinical dilemma – what to do with the patientwith unruptured giant aneurysm of basilar artery, withadded risk factors for cerebrovascular illness: arterial hy-pertension, atherosclerosis, adiposity, to decide whetherendovascular or operative or conservative treatment?The examples from literature, as well as from clinicalpractice showed that the decision is individual, concern-ing risk factors and the greatness of aneurysm.The risk of death is to high for non operated aneury-sms for the reason of emolisation of intraaneurysmaticsituated thromb and followed ischaemia distal from an-eurysm and possibility of rupture, and it is 14.5%–40%7.The data from literature show always the same dilemma:surgery (operation) or endovascular (coil placing) or con-sevative treatment1,7–9,16–20. The lowest risk for rupturehas the aneurysm located in the anterior circulation ifnot greater from 10 mm in diameter. The greatest riskfor rupture has aneurysm 10 mm in diameter or biggerlocated in posterior circulation. The risk can be makelower by very careful anticoagulation, antihypertensivetherapy, avoiding of physical activities and by lowering ofother risks, but epidemiological data are not very goodand took about very high grade of individuality, furtherof death during next 5 years1,8.In the decision of therapeutic treatment very impor-tant role has the configuration of aneurysm. If it is longishand narrow, it is better for coil, and otherwise not10,16–20.ISAT study has prooved that therapeutic decision of rup-tured intracranial aneurysm is same good endovascularand neurosurgical treatment, but concerning risks fromnew bleeding is more frequent of endovascular treat-ment11. Recovering of the patient with the damage ofposterior circulation, whether if it is infarct of aneurysm,need very careful physical therapy with limited posi-bilities of recovery of neurological atacks: walk-balance,sight, sensory funcitions12–15.Diagnosis will be given trought non invasive and inva-sive diagnostic treatment, near interdisciplinary cooper-ation of neurologist and neurosurgeon with radiologist--neuroradiologist, anesthesiologist, as well as doctor knownrisk factors and possible decisions, to get the highestquality of life of such patients.The patient from our description died for the reasonof massive ischaemic cerebral infarct which developed asconsequence of mobilisation of intraaneurysmatic situ-ated thromb distal from aneurysm 24 hours after start-ing of headache, and after that comma statement and notfor the reason of rupture of aneurysm. Unfortunatelly,autopsy was not done (family overload).R E F E R E N C E S1. AMINOFF MJ, DAROFF R, Encyclopedia of the neurological sci-ences, 1 (2003) 161. — 2. BENDESZUS M, BARTSCH AJ, SOLYMOSI L,Stroke, 38 (2007) 2855. — 3. BENDESZUS M, SOLYMOSI L, Am J Neu-roradiol, 27 (2006) 2053. — 4. OGILVY CS, CARTER BS, Neurosurgery,52, (2003) 82. — 5. OGILVY CS, HOH BL, SINGER RJ, PUTMAN CM,Neurosurgery, 51 (2002) 14. — 6. PIEROT L, BONAFE A, BRACARD S,LECLERC X, Am J Neuroradiol, 27, (2006) 1693. — 7. MEYER-LINDEN-BERG A, MEWES J, BINIEK R, Der Nervenarzt, 68 (1997) 674. — 8.AMMERER HP, DOBNER T,IVE-SCHAPPELWEIN, LOYDDINUM, JNeurol Neurochir Psychiatr, 4 (2003) 14. — 9. NATIONAL INSTITUTEL. [apina et al.: Giant Aneurysm of Basilar Artery, Coll. Antropol. 35 (2011) 2: 607–609608Fig. 1.OF NEUROLOGICAL DISORDERS AND STROKE, Cerebral aneurysmfact sheet. NINDS. November 2009. NIH Publication No. 08-5505. — 10.JOHNSTON SC, GRESS DR, KAHN JG, Neurology, 52 (1999) 1806. —11.MOLYNEUX A, KERR R, STRATTON I, SANDECOCK P, CLARKEM, SHRIMPTON J, HOLMAN R, Lancet, 360 (2002) 1267. — 12. BAR-KER FG 2nd, AMIN-HANJANI S, BUTLER WE, HOHN BL, RABINOVJD, JAMES D, PRYOR JC, OGILVY CS, CARTER BS, Neurosurgery, 54(2004) 18. — 13.CLINCHOT DM,KAPLAN P, MURRAY DM, PEASE WS,Arch Phys Med Rehabil, 75 (1994) 1342. — 14. NG YS, STEIN J, SALLESSS, BLACK-SCHAFFER RM, Arch Phys Med Rahabil, 86 (2005) 2138. —15. ZOROWITZ RD, Top Stroke Rehabil, 12 (2005) 50. — 16.ZHU YQ, LIMH, FANG C, TAN HQ, WANG W, ZHANG PL, CHENG YS, WANG JB,MA LT, J Endovasc Ther, 17(1) (2010) 55. — 17.TAN HQ, LI MH, LI YD,FANG C, WANG JB, WANG W, WANG J, ZHANG PL, ZHU YQ, Cere-brovasc Dis, 31(2) (2010) 154. — 18.WANG JB, LI MH, FANG C, WANGW, CHENG YS, ZHENG PL, DU ZY, WANG J, Neurosurgery, 62(5) (2008)1176. — 19. WEHMAN JC, HANEL RA, LEVY EL, HOPKINS LN, Neu-rosurgery, 5 Suppl 3 (2006) S125. — 20.VAN ROOIJ WJ, SLUZEWSKI M,AJNR Am J Neuroradiol, 30(1) (2009) 12.L. [apina»Dr. Josip Ben~evi}« General Hospital, Department of Neurology, A. [tampara 42, 35000 Slavonski Brod, Croatiae-mail: lsapina@net.hrGIGANTSKA ANEURIZMA ARTERIJE BAZILARISS A @ E T A KU ~lanku smo prikazali bolesnicu sa nerupturiranom gigantskom aneurizmom arterije bazilaris, prikazali u~injenepretrage, te terapijske dileme {to u~initi u konkretnom slu~aju. U literaturi smo na{li niz primjera koji govore u prilogoperativnom lije~enju, ali i embolizaciji, dok dio stru~njaka zagovara konzervativni tretman.L. [apina et al.: Giant Aneurysm of Basilar Artery, Coll. Antropol. 35 (2011) 2: 607–609609

Giant Aneurysm of Basilar Artery

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