FIGURE 4.

Imaging studies of a 20-yr-old woman with a giant/large fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction (BTVBJ-GFDA) presenting with brainstem compression syndrome. She underwent immediate proximal parent artery occlusion (IPO) treatment with high-flow saphenous vein graft bypass from the external carotid artery (ECA) to the posterior cerebral artery (PCA). A, Preoperative left vertebral angiogram demonstrated BTVBJ-GFDA. B, Preoperative T1-weighted MR image demonstrated significant brainstem compression by the aneurysm. C, Postoperative left vertebral artery angiograms showed disappearance of the BTVBJ-GFDA. The arrows are pointing at clips used for IPO. D, Postoperative right common carotid artery angiogram demonstrated patent ECA to PCA bypass.