Basilar artery perforator aneurysms: Report of 9 cases and review of the literature

Abstract

Basilar perforator artery aneurysms (BAPA s) are an under-recognised cause of sub-arachnoid haemorrhage (SAH). We present our single centre experience of BAPA s and review of the literature. We performed a retrospective review of our prospectively maintained database to identify all BAPA s that presented acute SAH between February 2009 and February 2018. We identified 9 patients (male\u202f=\u202f7), each with a single aneurysm, and average age 55\u202f±\u202f9.7\u202fyears. All aneurysms were small, 2.1\u202f±\u202f0.5\u202fmm (range 1-3\u202fmm). Three aneurysms were not detected on initial angiography. Six aneurysms were treated with flow diversion, 3 were managed conservatively. No repeat haemorrhage occurred in the flow diverted patients. One patient treated conservatively suffered a repeat haemorrhage and died (mRS 6). Follow up imaging (n\u202f=\u202f7), at average 5.6\u202fmonths (range 3-12\u202fmonths), showed complete occlusion in all the flow-diverted aneurysms and no change in one conservatively managed patient. There was no evidence of perforator infarction on the follow-up post treatment imaging. Clinical follow-up data was available in 8 patients, 6 of whom (75%) had a good outcome (mRS\u202f≤\u202f2). A high index of suspicion is required to diagnose BAPA. Flow diversion can be used to treat BAPA s with acceptable risk of perforator infarction and low risk of repeat haemorrhage.