TREATMENT OF DISSECTING BASILAR ARTERY ANEURYSM BY FLOW REVERSAL

Dissecting aneurysm of the basilar artery is a rare but increasingly r ecognized entity, with a frequently fatal or morbid outcome. Unlike th e well established proximal occlusion and trapping approaches to verte bral artery dissections, surgical intervention for basilar lesions has been limited to wrapping techniques for arterial wall reinforcement. We report a case of midbasilar dissecting aneurysm successfully treate d by clipping the proximal basilar artery below the level of the anter ior inferior cerebellar arteries, allowing retrograde flow via the pos terior communicating arteries to provide continued basilar perfusion. With the growing recognition of basilar dissection and pseudoaneurysm formation there is a need for improved therapeutic options. We suggest that definitive treatment can be achieved using the principle of prox imal occlusion and flow reversal, and review the pertinent literature on basilar artery dissection.