Cerebral artery fenestrations are rare congenital anatomical variations. They most frequently occur in the basilar artery, second only to the anterior-communicating region. The prevalence of these variations varies among cases and imaging study types, ranging from 0.31% using digital subtraction angiography (DSA)1 to 2.77% on MRI angiography.2 In a systematic review, at least 1 aneurysm was found in 60.5% of cases, with an aneurysm arising from the fenestration in 19.6%.3
In this case, a 51-year-old woman suddenly experienced right facial palsy, followed by intermittent facial spasms. Her condition worsened over 3 months, and an MRI angiography revealed a dilation in the inferior third of the basilar artery. Diagnostic DSA confirmed the diagnosis of a type 2B fenestrated basilar artery aneurysm, according to the Trivelato classification.4 Notably, both anterior inferior cerebellar arteries originated from each branch of the basilar artery's fenestrations.
After considering many options, we decided that the best alternative was to treat the aneurysm with stent-assisted coil embolization.5 The stent was deployed, extending from the right fenestration to the left vertebral artery, followed by coil deployment through the struts.
After embolization, the patient's spasms significantly decreased. One-year follow-up DSA revealed a coil cast with no flow into the aneurysm. In addition, both fenestration branches remained patent, with blood flow preserved in both anterior inferior cerebellar arteries. The following clinical video was produced in accordance with our internal Institutional Review Board regulations. Patient data have been anonymized, and no identifiable pictures or information was included in this video. Hence, patient consent was not required.
Acknowledgments
Author Contribution: Hector R. Martínez: conceptualization, methodology, project administration, investigation, supervision, resources, writing—original draft. Rogelio E. Flores-Salcido: writing—review and editing, software, resources, data curation, visualization, investigation. Jose A. Moran-Guerrero: writing—review and editing, software, data curation, visualization, investigation. Luis E. Perez-Martinez: writing—review and editing, investigation, methodology, validation. Marcos Vinicius Sangrador-Deitos: writing—review and editing, validation, resources. J. Antonio Infante Cantú: writing—review and editing, validation, supervision, conceptualization. Jose A. Figueroa-Sanchez: conceptualization, project administration, investigation, supervision, resources, methodology, writing—original draft.
Funding
This study did not receive any funding or financial support.
Disclosures
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
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