Abstract
Background and Purpose: The treatment of vertebro-basilar junction (VBJ) giant aneurysms (GA) remains a challenging task in the neurosurgical practice and the gold standard therapy is still under debate. Through a detailed post-mortem study, the authors analyze the hemodynamic factors underlying the formation and recanalization of an aneurysm located at this particular site and its anatomic configuration.
Methods: An adult fixed cadaveric specimen with a known VBJ GA, characterized radiographically and treated with endovascular embolization, was studied. 3-D computational fluid dynamic (CFD) models were built based on the specific angio-architecture of the specimen and each step of the endovascular treatment was simulated.
Results: The 3-D CFD study showed at the neck region of the aneurysm, an area of hemodynamic stress (high wall shear stress, high static pressure, high flow velocity), matching the site of recanalization seen during the treatment period of the patient.
Conclusions: Aneurysm morphology, location and patient specific angio-architecture are the principal factors to be considered in the management of the VBJ giant aneurysms. The 3-D CFD study is valuable tool that, coupled with the neuro-radiological work-up, may add valuable insights in the treatment planning of complex cerebrovascular diseases.