Basilar Tip Aneurysm

Contributor:

Dr. Chris Ekong

Case 13

Age: 42

Sex: Male

History: Patient with Known ankylosing spondylitis. Sudden severe headache. Examination shows him to be alert but with marked neck stiffness

Questions

Now what?

Clipping or coiling/balooning?

To The Neurorounds Group - July 26, 2002

Dear Max, Chris, Mike, Bob, Philippe, and Genevieve:

I have a 42-year-old man with a known history of ankylosing spondylitis who suddenly developed a very severe headache five days ago. Examination showed him to be quite uncomfortable from the headache and he had marked neck stiffness but was otherwise neurologically intact. CT of the head confirmed extensive subarachnoid hemorrhage and the angiogram showed a basilar tip aneurysm. The images are located above.

What would you like to do - coiling, ballooning or clipping? Your opinion would be appreciated.

Thank you.

Yours sincerely,

Chris

Dr. Mike Tymianski, Neurosurgeon, Toronto - July 26, 2002

Hi Chris.

Nice case.

1. Needs to be treated.

2. Would benefit from a 3D angio to look at the neck.

3. If suitable for coiling +/- baloon assist - would go in that direction.

4. If coil fails - would operate. Has a nice, high bifurcation (easy access), Rt P1 is higher, so would approach from that side as it is more likely to contain the dominant thalamic perforators (more easy to dissect away).

Please let me know if you need assist.

Best,

Mike Tymianski

Dr. Jean-Luc Gariepy, Neurosurgeon, Montreal - July 26, 2002

Hi Chris

What a great way to send some cases. Although we don't have the whole angiogram I should the case to my endovascular collegue and we both feel that the neck is not too wide. It is a p1 aneurysm. Would favor endovascular treatment .

Good luck

DR. Chris Ekong , Neurosurgeon, Regina - July 27, 2002

Patient sent to Toronto for coiling.

Dr. Mike Tymianski, Neurosurgeon, Toronto - July 29, 2002

Hi Chris.

Patient got coiled. Very nice result (100% obliteration) and neuro intact.

Had headache over weekend- CT: No bleed, no hydro. Headache improved by

today.

He wants to go home. Can we send him back to you?

I recommend he stay inpatient (close to home) until spasm period over.

Best

Mike T

DR. Chris Ekong , Neurosurgeon, Regina - September 11, 2002

- July 27, 2002- Patient back in Regina. Neurologically intact.

-July 30, 2002- Patient discharged home.

-Sept 10, 2002- Patient reviewed in office. No headaches. We'll repeat angio in 6 months

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