J Neurol Surg A Cent Eur Neurosurg 2015; 76(01): 79-82
DOI: 10.1055/s-0033-1356488
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Surgical Clipping of a Basilar Perforator Artery Aneurysm: A Case of Avoiding Perforator Sacrifice

Sananthan Sivakanthan
1   Department of Neurosurgery, University of South Florida, Tampa, Florida, United States
Andrew P. Carlson
1   Department of Neurosurgery, University of South Florida, Tampa, Florida, United States
Harry van Loveren
1   Department of Neurosurgery, University of South Florida, Tampa, Florida, United States
Siviero Agazzi
1   Department of Neurosurgery, University of South Florida, Tampa, Florida, United States
› Author Affiliations
Further Information

Publication History

03 February 2013

07 June 2013

Publication Date:
11 August 2014 (online)


Background Aneurysms arising from basilar perforator arteries are very rare. A primary goal of surgery is always preservation of perforator flow. However, in most surgically managed cases in the literature, sacrifice of the perforator was reported. It is important for the literature to demonstrate that patency of the perforator is an achievable goal.

Objective To present the second reported case of perforator flow preservation in the surgical management of basilar perforator artery aneurysms.

Clinical Presentation A 45-year-old woman presented with World Federation of Neurologic Surgeons grade 1 subarachnoid hemorrhage. Digital subtraction angiography ultimately revealed a 2-mm aneurysm of the basilar artery arising from a perforator after an initially negative angiogram. Clipping was performed with perforator patency confirmed on direct inspection and intraoperative angiography. The patient's postoperative course was uneventful, and postoperative magnetic resonance imaging (MRI) showed no evidence of brainstem stroke.

Conclusion Although patency of the perforator is a rather obvious goal of cerebrovascular surgery, the current literature does not reflect an ability to do so in the case of basilar perforator aneurysms. We present only the second reported case of maintenance of perforator flow after clipping of a basilar perforator artery aneurysm.

  • References

  • 1 Ghogawala Z, Shumacher JM, Ogilvy CS. Distal basilar perforator artery aneurysm: case report. Neurosurgery 1996; 39 (2) 393-396
  • 2 Deshaies EM, Jacobsen W, Krishnamurthy S. Enterprise stent-within-stent embolization of a basilar artery perforator aneurysm. WJNS 2011; 1 (3) 45-48
  • 3 Chen L, Chen E, Chotai S, Tian X. An endovascular approach to ruptured aneurysms of the circumferential branch of the basilar artery. J Clin Neurosci 2012; 19 (4) 527-531
  • 4 Nyberg EM, Chaudry MI, Turk AS , et al. Report of two cases of a rare cause of subarachnoid hemorrhage including unusual presentation and an emerging and effective treatment option. J Neurointerv Surg 2013; 5 (5) e30
  • 5 Klisch J, Turk A, Turner R, Woo HH, Fiorella D. Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. AJNR Am J Neuroradiol 2011; 32 (4) 627-632
  • 6 Siddiqui AH, Abla AA, Kan P , et al. Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms. J Neurosurg 2012; 116 (6) 1258-1266
  • 7 Fiorella D, Hsu D, Woo HH, Tarr RW, Nelson PK. Very late thrombosis of a pipeline embolization device construct: case report. Neurosurgery 2010; 67 (3, Suppl Operative ): E313-E314 ; discussion E314
  • 8 Hamel W, Grzyska U, Westphal M, Kehler U. Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir (Wien) 2005; 147 (12) 1283-1286
  • 9 Mathieson CS, Barlow P, Jenkins S, Hanzely Z. An unusual case of spontaneous subarachnoid haemorrhage—a ruptured aneurysm of a basilar perforator artery. Br J Neurosurg 2010; 24 (3) 291-293
  • 10 Apok V, Tarnaris A, Brydon HL. An unusual aneurysm of a basilar perforating artery presenting with a subarachnoid haemorrhage. Br J Neurosurg 2013; 27 (1) 105-107
  • 11 Gross BA, Puri AS, Du R. Basilar trunk perforator artery aneurysms. Case report and literature review. Neurosurg Rev 2013; 36 (1) 163-168 ; discussion 168
  • 12 Sanchez-Mejia RO, Lawton MT. Distal aneurysms of basilar perforating and circumferential arteries. Report of three cases. J Neurosurg 2007; 107 (3) 654-659
  • 13 Park SQ, Kwon O-K, Kim SH, Oh CW, Han MH. Pre-mesencephalic subarachnoid hemorrhage: rupture of tiny aneurysms of the basilar artery perforator. Acta Neurochir (Wien) 2009; 151 (12) 1639-1646