Elsevier

World Neurosurgery

Volume 108, December 2017, Pages 991.e7-991.e12
World Neurosurgery

Case Report
Staged Trapping of Traumatic Basilar Trunk Pseudoaneurysm: Case Report and Review of Literature

https://doi.org/10.1016/j.wneu.2017.08.144Get rights and content

Background

Traumatic intracranial aneurysms (TICAs) of the posterior circulation in the pediatric populations are rare. Only a few reports in the literature document basilar artery TICA in the pediatric population. These cases were typically associated with a clival fracture and commonly diagnosed weeks to months after trauma. We present a case of a patient with a basilar TICA diagnosed after a motor vehicle collision treated with staged trapping and review of the literature.

Case Description

We present a case of a 14-year-old boy who sustained a high-speed motor vehicle collision and developed a basilar trunk TICA identified on admission. Initially, the patient underwent craniotomy for proximal sacrifice of the basilar artery in hope for spontaneous thrombosis of the aneurysm through flow reversal. Endovascular options were reviewed and felt to be less feasible than surgical trapping. Due to continued filling through the right posterior communicating artery, the second surgery was performed to distally trap the aneurysm. The aneurysm was opened, showing some thrombosis and the absence of flow. Repeat magnetic resonance imaging did not reveal any new infarction, and the patient was discharged with neurologic improvement over time. At 1 year, he was able to ambulate unassisted and had a modified Rankin Scale score of 3.

Conclusion

Development of a TICA may be more acute than literature previously suggested. Treatment consists of a wide range of options and should be considered, especially in the pediatric population, to prevent rupture. Trapping can be performed safely if adequate collateral flow is present in the setting of a large basilar artery aneurysm.

Section snippets

Background

Intracranial aneurysms can be infectious, traumatic, or congenital in nature. Traumatic intracranial aneurysms (TICAs) account for <5% of all aneurysms in the pediatric population.1, 2 They can be a result of a penetrating or blunt head injury.3 Some iatrogenic cases have also been reported in children and adults after intracranial surgery.4, 5, 6, 7 TICAs are most commonly found in the anterior circulation8, 9, 10, 11, 12 and are histologically pseudoaneurysms. Their lack of an intact vascular

History and Examination

A 14-year-old boy presented in the emergency department after being a passenger in a high-velocity motor vehicle collision. The patient presented with a Glasgow Coma Scale of 6T with left hemiplegia. His head computed tomography showed multiple skull base fractures with underlying subarachnoid hemorrhage (SAH) in the posterior fossa (Figure 1). The skull fractures involved the cribriform plate, left orbital roof, sphenoid bone with extension into both carotid canals, and bilateral temporal bone

Discussion

To our knowledge, this is the first case report of a pediatric basilar trunk traumatic intracranial aneurysm (TICA) following a blunt trauma diagnosed on the day of admission. The reported incidence of TICAs is low compared with other types of aneurysms,9 and they are thought to represent <5% of all intracranial aneurysms in the pediatric population.1, 2, 29 TICAs have been described after a penetrating or blunt trauma. TICAs associated with a nonpenetrating trauma have been reported after a

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    Conflict of interest statement: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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