Giant dissecting aneurysm of basilar artery in a child – treated by flow reversal: A case report

Although intracranial aneurysms are rare in the paediatric population, the proportion of those involving posterior circulation is higher than that of adults (approximately 25% vs. 8%, respectively). Moreover, posterior circulation aneurysms in kids tend to be larger in size, many of them being giant dissecting types, and treatment of them is often challenging. Treatment of giant dissecting aneurysms, especially involving the Basilar artery is difficult due to strategic location and haemodynamic factors. Use of reconstructive techniques viz. flow-diverters and braided stents is difficult in children because of the lack of standard protocol for use of antiplatelet therapy and the need for prolonged use of the same. Continuous growth of parent vessel is also suggested as a pitfall for the use of a flow diverter/ braided stent which has a fixed caliber. Carefully planned endovascular parent or feeder branch artery occlusion (FAO) is a time-tested method to achieve flow reversal or favourable flow modifications in an arterial segment harbouring dissecting aneurysm. Here, in this case report, we describe a case of a ruptured distal giant basilar artery dissecting aneurysm in a 10-year-old boy treated with flow diversion by FAO. The dominant left vertebral artery was occluded, thereby diverting flow from the right vertebral artery towards the left posterior inferior cerebellar artery and decreasing flow through the aneurysm. On 1-year follow-up, the patient was asymptomatic and on check angiography, there was complete involution of the aneurysm with increased flow through bilateral posterior communicating arteries to distal posterior circulation which proved our hypothesis correct.