Basilar artery perforator aneurysms: a comparison with non-perforator saccular aneurysms

Area of Science:

• Neurosurgery
• Neuroradiology
• Vascular Neurology

Background:

• Basilar artery perforator aneurysms (BAPAs) are rare and lack systematic description.
• Comparison with conventional non-perforator aneurysms is needed for understanding their characteristics.

Purpose of the Study:

• To compare the presentation, imaging features, natural history, and outcomes of BAPAs with non-perforator aneurysms.
• To evaluate the utility of CT angiography (CTA) and vessel wall imaging (VWI) in diagnosing BAPAs.

Main Methods:

• Retrospective review of a prospective neurovascular database for BAPA cases.
• Comparison with a consecutive series of patients with non-perforator aneurysms.
• Analysis of blood volume on CT and VWI characteristics.

Main Results:

• BAPAs were more common in males and presented with similar severity and hydrocephalus as other aneurysms.
• CTA frequently missed BAPAs, while VWI showed characteristic thick, bright enhancement.
• Most BAPAs (6/9) thrombosed spontaneously; conservative management was effective, with no rebleeds.

Conclusions:

• BAPAs, despite small size, cause significant subarachnoid hemorrhage (SAH) and hydrocephalus.
• VWI is crucial for identifying BAPAs missed by CTA.
• Conservative management with observation for growth is a viable strategy, leading to good outcomes.