Basilar artery fenestration aneurysms treated with guglielmi detachable coils

Four patients with basilar artery fenestration aneurysms at the vertebra basilar junction were admitted after subarachnoid haemorrhage. In two of them attempted surgery failed. Subsequently, all four were embolised with Guglielmi Detachable Coils (GDC), three of them in the acute phase. In one case the initial embolisation was incomplete, but follow-up angiography demonstrated spontaneous total occlusion. In another, partial reopening was treated with further embolisation. Three patients recovered completely after treatment. One patient still has deficits related to surgery of an accompanying aneurysm at the middle cerebral artery. He is clinically improving but still not back at work. In two cases the fenestration was combined with a hypoplastic upper vertebral artery on one side. A hypoplastic veretebral artery on one side may frequently be part of the developmental anomaly of basilar fenestration aneurysms. The anatomical configuration and location of these aneurysms is such that their true nature is sometimes difficult to disclose at cerebral angiography and is only realised during embolisation. Treatment with GDC coils seems superior to surgery in basilar artery fenestration aneurysms.