{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:05:53Z","timestamp":1789113953535,"version":"build-2803163510"},"reference-count":25,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Giant basilar tip aneurysms remain difficult to treat due to their location, bifurcation anatomy, adjacent perforators, and potential for mass effect. Endovascular treatment, including stent-assisted coiling, is a valuable option. Despite angiographic occlusion, mass effect may still be clinically significant.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n A 67-year-old man presented with headache and was diagnosed with a 27 \u00d7 17-mm giant unruptured basilar tip aneurysm. Preoperative angiography demonstrated perforators arising predominantly from the left P1 segment and a well-developed right posterior communicating artery (PComA), while the left PComA was hypoplastic. Stent-assisted coiling was performed with stent placement from the basilar artery to the left posterior cerebral artery and occlusion of the non-stented right P1 segment. The early postoperative course was uneventful. Posterior tilting of the coiled aneurysm was first noted 1 week after treatment and subsequently progressed. Approximately 3 months after treatment, mass effect resulted in midbrain compression and obstructive hydrocephalus. Skull radiographs in different body positions demonstrated posture-dependent displacement of the coil mass, suggesting a role of gravity. Levodopa administration and ventriculoperitoneal shunting resulted in partial symptomatic improvement. Angiographic follow-up through 3 years demonstrated stable occlusion without recurrence, with no substantial progression of posterior tilting after the first postoperative year.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Stent-assisted coiling with therapeutic P1 occlusion may contribute to durable angiographic occlusion in selected giant basilar tip aneurysms. However, delayed posterior tilting of the coiled aneurysm may occur as a postoperative phenomenon. This potential delayed complication, leading to mass effect, should therefore be considered in treatment strategy and postoperative follow-up.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_689_2026","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T07:09:28Z","timestamp":1789110568000},"page":"514","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed posterior tilting of a giant basilar tip aneurysm following stent-assisted coiling with therapeutic P1 occlusion: A case 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