Basilar Tip Aneurysm
A 40-year-old female presented to our neurosurgery clinic with a family history of subarachnoid hemorrhage. A screening MRA of the head demonstrated a basilar tip aneurysm. She underwent a diagnostic cerebral angiogram, which demonstrated a wide-necked basilar tip aneurysm measuring 4.1mm in width and 3.8mm in height. All options for endovascular treatment of a wide-necked basilar aneurysm were discussed with the patient, including balloon-assisted coiling, stent-assisted coiling or placement of Woven EndoBridge (WEB) device. The WEB device is a permanent nitinol (nickel titanium) self-expanding mesh ball implant for the treatment of wide-necked intracranial aneurysms located at four locations: middle cerebral artery (MCA) bifurcation, anterior communicating artery (AComm), internal carotid artery (ICA) terminus, and basilar artery apex. The FDA approved the WEB Aneurysm Embolization System on December 31, 2018. The patient elected for WEB, and a 5x3mm WEB device was successfully deployed in the basilar apex aneurysm. She was placed on aspirin 325mg post-procedure and was discharged to home on postoperative day 1.
Figure 1: (A) Left vertebral artery cranial injection anteroposterior view demonstrating a wide-necked basilar apex aneurysm measuring 4.1mm in width and 3.8mm in height. (B) 3-dimensional reconstruction showing the wide-necked configuration of the basilar apex aneurysm.
Figure 2: (A) Treatment view of the WEB device being deployed from the microcatheter in the basilar apex aneurysm. (B) Unsubtracted AP injection showing WEB device (two markers) deployed in the basilar apex aneurysm with filling of all the major arteries arising from the basilar apex.
Figure 3: Left vertebral artery cranial injection (A) anteroposterior and (B) lateral views demonstrating successful deployment of WEB device with contrast stasis suggesting stagnation of flow in the basilar apex aneurysm.
Rimal H. Dossani MD, Muhammad Waqas MD, Michael Tso MD PhD, Gary Rajah MD, Adnan H. Siddiqui MD PhD
University at Buffalo Department of Neurosurgery