Partial Clipping and Multilayered Wrapping Using Collagen Matrix for Partially Thrombosed Basilar Trunk Aneurysm: A Technical Case Report

Abstract

Treatment of basilar artery trunk aneurysms is still challenging today, although numerous approaches and modalities of treatment exist. The authors present a case of a patient with a partially thrombosed, ruptured basilar trunk artery aneurysm successfully treated by clipping occlusion of the rupture point and multilayered wrapping of the aneurysmal dome. A 49-year-old man presented to our emergency room with a chief complaint of altered mental status. The patient was diagnosed with subarachnoid hemorrhage (SAH). No apparent bleeding point was identified on initial 3-dimension computerized tomography (CT) angiography and digital subtraction angiography (DSA). Follow-up DSA revealed a partially thrombosed saccular aneurysm emerging from the basilar trunk. We decided to treat the aneurysm surgically with partial clipping including the bleb and wrapping via the anterior transpetrosal approach. The surgery was performed successfully without any complications, and the residual blood flow within the aneurysm diminished remarkably over time. Although direct clipping and wrapping for basilar trunk artery aneurysms is one of the most challenging operations, it is a highly effective treatment for complex aneurysms, especially if other treatments are not available.