{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T13:34:24Z","timestamp":1781357664621,"version":"3.54.1"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n Intracranial arterial dolichoectasia (IADE), also known as dilative arteriopathy, is a vascular disorder characterized by arterial elongation, dilation, and tortuosity, predominantly affecting the vertebrobasilar system. Fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar system are a rare but challenging subset of aneurysms associated with IADE, exhibiting a high recurrence rate and limited treatment options. Flow diversion has emerged as an endovascular treatment approach for managing these aneurysms, although it does come with significant risks.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 54-year-old patient presented with a large fusiform basilar trunk aneurysm (BTA) secondary to IADE and underwent flow diversion with Pipeline embolization devices. Despite initial stabilization, the aneurysm recurred multiple times over several years, requiring additional flow diversion procedures. The patient later developed hydrocephalus, necessitating placement of a ventriculoperitoneal shunt, which was complicated by a basilar artery thrombus and ischemic stroke requiring thrombectomy. Long-term follow-up revealed ongoing aneurysm remodeling and persistent symptoms.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights the challenges of managing recurrent dolichoectatic BTAs with flow diversion, the importance of long-term surveillance, and the risk of complications, including hydrocephalus and ischemic events, following intervention. Individualized treatment strategies are essential to mitigate complications and optimize outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25131<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25131","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:27:40Z","timestamp":1758587260000},"source":"Crossref","is-referenced-by-count":1,"title":["Treatment pitfalls in recurrent dolichoectatic basilar trunk aneurysm with flow diversion: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3350-9830","authenticated-orcid":true,"given":"Mikaeel A.","family":"Habib","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8159-2339","authenticated-orcid":true,"given":"Aaron","family":"Anandarajah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis O.","family":"Tierradentro-Garcia","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeha","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar A.","family":"Choudhri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Ann Neurol","first-page":"469","article-title":"Dilatative arteriopathy (dolichoectasia): what is known and not known","volume":"57","author":"Caplan","year":"2005","unstructured":"Caplan LR.Dilatative arteriopathy (dolichoectasia): what is known and not known. Ann Neurol. 2005;57(4):469-471."},{"issue":"4","key":"bib2","series-title":"J Clin Neuroophthalmol","first-page":"249","article-title":"Dolichoectasia and cranial nerve palsies. A case report","volume":"9","author":"Durand","year":"1989","unstructured":"Durand JRSamples JR.Dolichoectasia and cranial nerve palsies. A case report. J Clin Neuroophthalmol. 1989;9(4):249-253."},{"issue":"3","key":"bib3","series-title":"Curr Treat Options Cardiovasc Med","first-page":"261","article-title":"Dolichoectasia of the intracranial arteries","volume":"13","author":"Kwon","year":"2011","unstructured":"Kwon HMLee YS.Dolichoectasia of the intracranial arteries. Curr Treat Options Cardiovasc Med. 2011;13(3):261-267."},{"issue":"1","key":"bib4","series-title":"Nat Rev Neurol","first-page":"41","article-title":"Dolichoectasia\u2014an evolving arterial disease","volume":"7","author":"Gutierrez","year":"2011","unstructured":"Gutierrez JSacco RLWright CB.Dolichoectasia\u2014an evolving arterial disease. Nat Rev Neurol. 2011;7(1):41-50."},{"issue":"8","key":"bib5","series-title":"Lancet Neurol","first-page":"833","article-title":"Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia","volume":"14","author":"Pico","year":"2015","unstructured":"Pico FLabreuche JAmarenco P.Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol. 2015;14(8):833-845."},{"issue":"2","key":"bib6","series-title":"Neurol Res","first-page":"131","article-title":"Clinical course and treatment of vertebrobasilar dolichoectasia: a systematic review of the literature","volume":"35","author":"Wolters","year":"2013","unstructured":"Wolters FJRinkel GJEVergouwen MDI.Clinical course and treatment of vertebrobasilar dolichoectasia: a systematic review of the literature. Neurol Res. 2013;35(2):131-137."},{"key":"bib7","series-title":"Clin Neurol Neurosurg","first-page":"108635","article-title":"Anatomical analysis of vertebral arteries in vertebrobasilar dolichoectasia: a multi-center study","volume":"247","author":"Moniz-Garcia","year":"2024","unstructured":"Moniz-Garcia DZermeno JRSingh RAnatomical analysis of vertebral arteries in vertebrobasilar dolichoectasia: a multi-center study. Clin Neurol Neurosurg. 2024;247:108635."},{"issue":"5","key":"bib8","series-title":"J Neurosurg","first-page":"1376","article-title":"Natural history of dolichoectatic vertebrobasilar aneurysms: a multinational study","volume":"142","author":"Rezai Jahromi","year":"2025","unstructured":"Rezai Jahromi BDashti ROta NNatural history of dolichoectatic vertebrobasilar aneurysms: a multinational study. J Neurosurg. 2025;142(5):1376-1386."},{"key":"bib9","series-title":"Front Neurol","first-page":"895527","article-title":"Prospects and dilemmas of endovascular treatment for vertebrobasilar dolichoectasia","volume":"13","author":"Wang","year":"2022","unstructured":"Wang YYu J.Prospects and dilemmas of endovascular treatment for vertebrobasilar dolichoectasia. Front Neurol. 2022;13:895527."},{"issue":"1-2","key":"bib10","series-title":"Cerebrovasc Dis","first-page":"68","article-title":"Natural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis","volume":"45","author":"Nasr","year":"2018","unstructured":"Nasr DMFlemming KDLanzino GNatural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis. Cerebrovasc Dis. 2018;45(1-2):68-77."},{"issue":"4","key":"bib11","series-title":"Stroke","first-page":"948","article-title":"Natural history and management of basilar trunk artery aneurysms","volume":"46","author":"Saliou","year":"2015","unstructured":"Saliou GSacho RHPower SNatural history and management of basilar trunk artery aneurysms. Stroke. 2015;46(4):948-953."},{"issue":"1","key":"bib12","series-title":"J Neurosurg","first-page":"72","article-title":"Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth","volume":"102","author":"Mangrum","year":"2005","unstructured":"Mangrum WIHuston JLink MJEnlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth. 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J Neurosurg. 2018;128(2):560-566."},{"issue":"1","key":"bib15","series-title":"Neurosurgery","first-page":"82","article-title":"Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction-clinicopathological and surgical outcome","volume":"88","author":"Nakatomi","year":"2020","unstructured":"Nakatomi HKiyofuji SOno HGiant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction-clinicopathological and surgical outcome. Neurosurgery. 2020;88(1):82-95."},{"issue":"5","key":"bib16","series-title":"Br J Neurosurg","first-page":"1184","article-title":"Unsuccessful bypass and trapping of a giant dolichoectatic thrombotic basilar trunk aneurysm. What went wrong?","volume":"38","author":"Montemurro","year":"2024","unstructured":"Montemurro NPerrini PLawton MT.Unsuccessful bypass and trapping of a giant dolichoectatic thrombotic basilar trunk aneurysm. What went wrong? Br J Neurosurg. 2024;38(5):1184-1187."},{"issue":"1","key":"bib17","series-title":"Neurosurgery","first-page":"83","article-title":"Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress","volume":"79","author":"Lawton","year":"2016","unstructured":"Lawton MTAbla AARutledge WCBypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. Neurosurgery. 2016;79(1):83-99."},{"issue":"2","key":"bib18","series-title":"J Neurosurg","first-page":"185","article-title":"Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms","volume":"84","author":"Anson","year":"1996","unstructured":"Anson JALawton MTSpetzler RF.Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg. 1996;84(2):185-193."},{"issue":"1","key":"bib19","series-title":"Acta Neurochir (Wien)","first-page":"173","article-title":"Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center","volume":"166","author":"Calvanese","year":"2024","unstructured":"Calvanese FAuricchio AMPohjola AChanges in treatment of intracranial aneurysms during the last decade in a large European neurovascular center. Acta Neurochir (Wien). 2024;166(1):173."},{"issue":"5","key":"bib20","series-title":"J Neurosurg","first-page":"1077","article-title":"The Pipeline embolization device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution","volume":"121","author":"Munich","year":"2014","unstructured":"Munich SATan LAKeigher KMChen MMoftakhar RLopes DK.The Pipeline embolization device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution. J Neurosurg. 2014;121(5):1077-1084."},{"issue":"4","key":"bib21","series-title":"Interv Neuroradiol","first-page":"434","article-title":"Treatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device","volume":"21","author":"Ahmed","year":"2015","unstructured":"Ahmed OStorey CKalakoti PTreatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device. Interv Neuroradiol. 2015;21(4):434-440."},{"issue":"2","key":"bib22","series-title":"AJNR Am J Neuroradiol","first-page":"176","article-title":"Safety and efficacy of low-profile braided stents versus flow diverters in the reconstructive technique in the treatment of patients with vertebrobasilar dolichoectasia aneurysms: a cohort of 47 patients with long-term follow-up","volume":"45","author":"Ji","year":"2024","unstructured":"Ji ZHe CLi JSafety and efficacy of low-profile braided stents versus flow diverters in the reconstructive technique in the treatment of patients with vertebrobasilar dolichoectasia aneurysms: a cohort of 47 patients with long-term follow-up. 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Neurosurg Focus. 2023;54(5):E9."},{"issue":"6","key":"bib25","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion","volume":"42","author":"Awad","year":"2017","unstructured":"Awad AJMascitelli JRHaroun RRDe Leacy RAFifi JTMocco J.Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion. Neurosurg Focus. 2017;42(6):E14."},{"issue":"1","key":"bib26","series-title":"Angiology","first-page":"17","article-title":"Current treatment strategies for intracranial aneurysms: an overview","volume":"69","author":"Zhao","year":"2018","unstructured":"Zhao JLin HSummers RYang MCousins BGTsui J.Current treatment strategies for intracranial aneurysms: an overview. Angiology. 2018;69(1):17-30."},{"issue":"2","key":"bib27","series-title":"Neurosurg Rev","first-page":"135","article-title":"Giant fusiform aneurysm of the vertebro-basilar artery presenting with stroke","volume":"18","author":"\u0130ldan","year":"1995","unstructured":"\u0130ldan F\u00c7etinalp EBagdatoglu HBoyar BUzuney\u00fcpoglu ZKaradayi A.Giant fusiform aneurysm of the vertebro-basilar artery presenting with stroke. Neurosurg Rev. 1995;18(2):135-138."},{"issue":"7","key":"bib28","series-title":"J Neurointervent Surg","first-page":"655","article-title":"Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters","volume":"15","author":"Siddiqui","year":"2023","unstructured":"Siddiqui AHMonteiro AHanel RATriple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters. J Neurointervent Surg. 2023;15(7):655-663."},{"issue":"4","key":"bib1","series-title":"Ann Neurol","first-page":"469","article-title":"Dilatative arteriopathy (dolichoectasia): what is known and not known","volume":"57","author":"Caplan","year":"2005","unstructured":"Caplan LR.Dilatative arteriopathy (dolichoectasia): what is known and not known. Ann Neurol. 2005;57(4):469-471."},{"issue":"4","key":"bib2","series-title":"J Clin Neuroophthalmol","first-page":"249","article-title":"Dolichoectasia and cranial nerve palsies. A case report","volume":"9","author":"Durand","year":"1989","unstructured":"Durand JRSamples JR.Dolichoectasia and cranial nerve palsies. A case report. J Clin Neuroophthalmol. 1989;9(4):249-253."},{"issue":"3","key":"bib3","series-title":"Curr Treat Options Cardiovasc Med","first-page":"261","article-title":"Dolichoectasia of the intracranial arteries","volume":"13","author":"Kwon","year":"2011","unstructured":"Kwon HMLee YS.Dolichoectasia of the intracranial arteries. Curr Treat Options Cardiovasc Med. 2011;13(3):261-267."},{"issue":"1","key":"bib4","series-title":"Nat Rev Neurol","first-page":"41","article-title":"Dolichoectasia\u2014an evolving arterial disease","volume":"7","author":"Gutierrez","year":"2011","unstructured":"Gutierrez JSacco RLWright CB.Dolichoectasia\u2014an evolving arterial disease. 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J Neurosurg. 2025;142(5):1376-1386."},{"key":"bib9","series-title":"Front Neurol","first-page":"895527","article-title":"Prospects and dilemmas of endovascular treatment for vertebrobasilar dolichoectasia","volume":"13","author":"Wang","year":"2022","unstructured":"Wang YYu J.Prospects and dilemmas of endovascular treatment for vertebrobasilar dolichoectasia. Front Neurol. 2022;13:895527."},{"issue":"1-2","key":"bib10","series-title":"Cerebrovasc Dis","first-page":"68","article-title":"Natural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis","volume":"45","author":"Nasr","year":"2018","unstructured":"Nasr DMFlemming KDLanzino GNatural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis. Cerebrovasc Dis. 2018;45(1-2):68-77."},{"issue":"4","key":"bib11","series-title":"Stroke","first-page":"948","article-title":"Natural history and management of basilar trunk artery aneurysms","volume":"46","author":"Saliou","year":"2015","unstructured":"Saliou GSacho RHPower SNatural history and management of basilar trunk artery aneurysms. Stroke. 2015;46(4):948-953."},{"issue":"1","key":"bib12","series-title":"J Neurosurg","first-page":"72","article-title":"Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth","volume":"102","author":"Mangrum","year":"2005","unstructured":"Mangrum WIHuston JLink MJEnlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth. J Neurosurg. 2005;102(1):72-79."},{"issue":"3","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"589","article-title":"Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils","volume":"34","author":"van Oel","year":"2013","unstructured":"van Oel LIvan Rooij WJSluzewski MBeute GNLohle PNPeluso JP.Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils. AJNR Am J Neuroradiol. 2013;34(3):589-595."},{"issue":"2","key":"bib14","series-title":"J Neurosurg","first-page":"560","article-title":"Dolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes","volume":"128","author":"Xu","year":"2018","unstructured":"Xu DSLevitt MRKalani MYSDolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes. J Neurosurg. 2018;128(2):560-566."},{"issue":"1","key":"bib15","series-title":"Neurosurgery","first-page":"82","article-title":"Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction-clinicopathological and surgical outcome","volume":"88","author":"Nakatomi","year":"2020","unstructured":"Nakatomi HKiyofuji SOno HGiant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction-clinicopathological and surgical outcome. Neurosurgery. 2020;88(1):82-95."},{"issue":"5","key":"bib16","series-title":"Br J Neurosurg","first-page":"1184","article-title":"Unsuccessful bypass and trapping of a giant dolichoectatic thrombotic basilar trunk aneurysm. What went wrong?","volume":"38","author":"Montemurro","year":"2024","unstructured":"Montemurro NPerrini PLawton MT.Unsuccessful bypass and trapping of a giant dolichoectatic thrombotic basilar trunk aneurysm. What went wrong? 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Interv Neuroradiol. 2015;21(4):434-440."},{"issue":"2","key":"bib22","series-title":"AJNR Am J Neuroradiol","first-page":"176","article-title":"Safety and efficacy of low-profile braided stents versus flow diverters in the reconstructive technique in the treatment of patients with vertebrobasilar dolichoectasia aneurysms: a cohort of 47 patients with long-term follow-up","volume":"45","author":"Ji","year":"2024","unstructured":"Ji ZHe CLi JSafety and efficacy of low-profile braided stents versus flow diverters in the reconstructive technique in the treatment of patients with vertebrobasilar dolichoectasia aneurysms: a cohort of 47 patients with long-term follow-up. AJNR Am J Neuroradiol. 2024;45(2):176-182."},{"issue":"10","key":"bib23","series-title":"Int J Med Sci","first-page":"1039","article-title":"Research progress on vertebrobasilar dolichoectasia","volume":"11","author":"Yuan","year":"2014","unstructured":"Yuan YJXu KLuo QYu JL.Research progress on vertebrobasilar dolichoectasia. Int J Med Sci. 2014;11(10):1039-1048."},{"issue":"5","key":"bib24","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Dolichoectatic vertebrobasilar aneurysms: a systematic review and meta-analysis of management strategies and outcomes","volume":"54","author":"Bin-Alamer","year":"2023","unstructured":"Bin-Alamer OQedair JPalmisciano PDolichoectatic vertebrobasilar aneurysms: a systematic review and meta-analysis of management strategies and outcomes. Neurosurg Focus. 2023;54(5):E9."},{"issue":"6","key":"bib25","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion","volume":"42","author":"Awad","year":"2017","unstructured":"Awad AJMascitelli JRHaroun RRDe Leacy RAFifi JTMocco J.Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion. Neurosurg Focus. 2017;42(6):E14."},{"issue":"1","key":"bib26","series-title":"Angiology","first-page":"17","article-title":"Current treatment strategies for intracranial aneurysms: an overview","volume":"69","author":"Zhao","year":"2018","unstructured":"Zhao JLin HSummers RYang MCousins BGTsui J.Current treatment strategies for intracranial aneurysms: an overview. 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