Basilar artery aneurysm at a persistent trigeminal artery junction. A case report and literature review.

The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature.

De novo basilar tip aneurysm. Case report and literature review.

The de novo aneurysms are the formation of new aneurysms in a location previously observed to be normal by a cerebral angiography or direct microsurgical exploration. In this report, we present a review of the theme and describe a case of a ruptured de novo basilar tip aneurysm in a patient previously treated with carotid occlusion for a giant intracavernous aneurysm and microsurgical clipping of contralateral posterior communicating artery aneurysm.

Giant intracranial pial arteriovenous fistula treated by endovascular intervention.

INTRODUCTION: Arteriovenous fistulas (AVF) are rare vascular lesions of the brain that differ from arteriovenous malformations as they present a direct connection between artery and vein, without interposition of the nidus. They are fed by one or more arterial branches, with a single draining vein. Clinically they can be revealed through cerebral hemorrhage, convulsive crisis, neurological deficit, heart failure in neonates and infants, headache, bruit, or intracranial hypertension symptoms. PATIENT AND METHODS: A 30-year-old patient was found unconscious on a public street, presenting a generalized tonic-clonic convulsive crisis. At admission, she presented with ocular proptosis, conjunctival hyperemia and bilateral jugular turgescence. The cranial computed tomography showed diffuse subarachnoid hemorrhage, and the cerebral angiography evidenced a giant intracranial pial AVF with high flow supplied by 2 branches of the left anterior cerebral artery.The patient underwent endovascular treatment in 2 sessions, using a mixture of histoacryl and lipiodol for complete occlusion of the lesion. She was discharged after a month, alert, devoid of motor deficit, and the ocular proptosis and the conjunctival hyperemia had decreased. CONCLUSION: AVFs are rare vascular lesions that require prompt treatment. The endovascular treatment must be considered, especially when the lesions are deep and the risks of neurological deficit associated with the surgery are high. Endoscopic intervention represents an effective and safe option for the treatment of this type of lesion.