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Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1738--1739

A Giant Thrombosed Vertebrobasilar Artery System Aneurysm Mimicking Brainstem Lesion

Gyani J S. Birua, Abhay Sikaria, Gaurav Tyagi, Manish Beniwal, Dwarakanath Srinivas 
 Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India

Correspondence Address:
Gyani J S. Birua
Department of Neurosurgery, NIMHANS, 2nd Floor, Right Wing, Faculty Building, Bengaluru, Karnataka

How to cite this article:
S. Birua GJ, Sikaria A, Tyagi G, Beniwal M, Srinivas D. A Giant Thrombosed Vertebrobasilar Artery System Aneurysm Mimicking Brainstem Lesion.Neurol India 2022;70:1738-1739

How to cite this URL:
S. Birua GJ, Sikaria A, Tyagi G, Beniwal M, Srinivas D. A Giant Thrombosed Vertebrobasilar Artery System Aneurysm Mimicking Brainstem Lesion. Neurol India [serial online] 2022 [cited 2022 Nov 30 ];70:1738-1739
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Full Text

Giant aneurysms of the vertebrobasilar system are not uncommon,[1] but a complete thrombosed aneurysm of vertebrobasilar aneurysm mimicking brainstem lesion is extremely rare. These aneurysms may induce symptoms suggesting a posterior fossa tumor.[2] Giant aneurysms of the posterior fossa are difficult to diagnose with angiography, especially in the case of complete thrombosis.[3] We are describing images of a giant thrombosed vertebrobasilar artery system aneurysm simulating a brainstem lesion.

A 21-year-old female had been suffering from sharp lancinating pain and paresthesia of the left side of the face for 2 months. She had a history of one episode of sudden excruciating headache 2 years ago, which started suddenly at the occipital region and became holocranial within minutes. However, it was not associated with loss of consciousness, vomiting, vertigo, or visual symptoms, and it subsided within 2 days with an analgesic. Hence, she did not consult a physician for further evaluation.

The patient was evaluated with magnetic resonance imaging (MRI). MRI brain revealed a large (2.4 × 2.4 × 4.4 cm), predominantly cystic lesion with an exophytic component in the pontomedullary part of the brainstem [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f, [Figure 1]g, [Figure 1]h, [Figure 1]i, [Figure 1]j, [Figure 1]k. Magnetic resonance angiography (MRA) revealed markedly attenuated caliber of the bilateral (right > left) vertebral arteries and the basilar artery [Figure 1].{Figure 1}

To further evaluate the attenuated bilateral vertebrobasilar arteries and to rule out any possible vascular anomaly, the patient was further evaluated with digital subtraction angiography (DSA), which revealed a fully thrombosed, dissecting giant vertebrobasilar artery system aneurysm [Figure 2].{Figure 2}

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


1Suzuki T, Kaku S, Nishimura K, Teshigawara A, Sasaki Y, Aoki K, et al. Multistage “Hybrid” (Open and endovascular) surgical treatment of vertebral artery-thrombosed giant aneurysm by trapping and thrombectomy. World Neurosurg 2018;114:144-50.
2Drake CG. Giant intracranial aneurysms: Experience with surgical treatment in 174 patients. Clin Neurosurg 1979;26:12-95.
3Spallone A. Giant, completely thrombosed intracranial aneurysm simulating tumor of the foramen magnum. Surg Neurol 1982;18:372-6.