Dissecting giant vertebro-basilar aneurysms.

ABSTRACT

OBJECT Vertebro-basilar dissecting aneurysms (VDAs) are very rare in children. Strokes or subarachnoid hemorrhage are characteristic clinical manifestations, but often only non-specific symptoms are found. Radiological diagnosis may be difficult to obtain and therapy hard to perform. We report on a child who presented with an intracranial mass effect due to a giant VDA. METHODS: The patient was a 8-year-old girl with right hemiparesis, ataxia, dysphagia and dysphonia and worsening of her neurological deficits. Neuroimaging discovered a giant dissecting aneurysm arising from the left vertebral artery and involving the vertebro-basilar junction. Endovascular treatment by coil embolization was performed. The post-operative course initially showed a remarkable improvement in her clinical condition. Afterwards, she developed cerebral hemorrhage and died. CONCLUSION: VDAs may have an unusual presentation and their therapy still remains a challenge. Endovascular embolization is a valid option but, as it is surgery, it may cause the death of the patient.