{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:32:44Z","timestamp":1769725964861,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"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 Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,11]]},"abstract":"\n BACKGROUND<\/jats:title>\n The management of large thrombosed unruptured vertebral artery (VA) aneurysms is complex and remains a significant clinical challenge.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 46-year-old man presented with a headache and was diagnosed with a thrombosed 28-mm aneurysm in the right VA. The initial treatment with a Pipeline flow diverter stent was followed by parent artery occlusion with coils after the aneurysm had enlarged to 40 mm. Subsequently, the patient experienced cardiopulmonary arrest owing to brainstem compression-induced respiratory failure. A surgical approach involving a thrombectomy via a lateral suboccipital craniotomy was used, resulting in significant clinical improvement. The patient was eventually transferred to a rehabilitation facility with a modified Rankin Scale score of 1 and continued to recover with time.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Although endovascular treatments are less invasive, they may be insufficient in cases with significant mass effects. Direct surgical intervention, including thrombectomy and coagulation of the vasa vasorum, can be an effective strategy to reduce the mass effect and halt aneurysm growth. Timely surgical intervention before the onset of severe symptoms is recommended to optimize outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25383<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25383","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T23:43:51Z","timestamp":1754955831000},"source":"Crossref","is-referenced-by-count":0,"title":["Successful surgical management of a recurrent thrombosed vertebral artery aneurysm following cardiopulmonary arrest induced by parent artery occlusion after flow diversion: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2665-6075","authenticated-orcid":true,"given":"So","family":"Ozaki","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0844-8577","authenticated-orcid":true,"given":"Taisuke","family":"Akimoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Moro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takafumi","family":"Kawasaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Sonoda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-6189","authenticated-orcid":true,"given":"Jun","family":"Suenaga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9956-2075","authenticated-orcid":true,"given":"Yasunobu","family":"Nakai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsumi","family":"Takizawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9977-9373","authenticated-orcid":true,"given":"Tetsuya","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"132","article-title":"Occult rupture of a giant vertebral artery aneurysm following proximal occlusion and intrasaccular thrombosis: case report","volume":"95","author":"Piepgras","year":"2001","unstructured":"Piepgras DGKhurana VGNichols DA.Occult rupture of a giant vertebral artery aneurysm following proximal occlusion and intrasaccular thrombosis: case report. J Neurosurg. 2001;95(1):132-137."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"468","article-title":"Angiographically occult, progressively expanding, giant vertebral artery aneurysm: case report","volume":"105","author":"Komotar","year":"2006","unstructured":"Komotar RJMocco JLavine SDSolomon RA.Angiographically occult, progressively expanding, giant vertebral artery aneurysm: case report. J Neurosurg. 2006;105(3):468-471."},{"key":"bib3","series-title":"Ther Adv Neurol Disord","first-page":"17562864231176187","article-title":"Flow diversion for posterior circulation aneurysms: a multicenter retrospective study","volume":"16","author":"Qi","year":"2023","unstructured":"Qi PTong XLiang XFlow diversion for posterior circulation aneurysms: a multicenter retrospective study. Ther Adv Neurol Disord. 2023;16:17562864231176187."},{"issue":"3","key":"bib4","series-title":"J Neuropathol Exp Neurol","first-page":"409","article-title":"A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian hospital, 1914 to 1956","volume":"17","author":"Housepian","year":"958","unstructured":"Housepian EMPoot JL.A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian hospital, 1914 to 1956. J Neuropathol Exp Neurol. 958;17(3):409-423."},{"key":"bib5","series-title":"World Neurosurg","first-page":"e507","article-title":"Long-term outcome of endovascular therapy for large or giant thrombosed intracranial aneurysms","volume":"144","author":"Enomoto","year":"2020","unstructured":"Enomoto YEgashira YMatsubara HYoshimura SIwama T.Long-term outcome of endovascular therapy for large or giant thrombosed intracranial aneurysms. World Neurosurg. 2020;144:e507-e512."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e164","article-title":"Flow diversion for treatment of partially thrombosed aneurysms: a multicenter cohort","volume":"135","author":"Foreman","year":"2020","unstructured":"Foreman PMSalem MMGriessenauer CJFlow diversion for treatment of partially thrombosed aneurysms: a multicenter cohort. World Neurosurg. 2020;135:e164-e173."},{"issue":"4","key":"bib7","series-title":"Neuroradiol J","first-page":"365","article-title":"Endovascular treatment of cerebral aneurysms using flow-diverter devices: a systematic review","volume":"28","author":"Briganti","year":"2015","unstructured":"Briganti FLeone GMarseglia MEndovascular treatment of cerebral aneurysms using flow-diverter devices: a systematic review. Neuroradiol J. 2015;28(4):365-375."},{"issue":"5","key":"bib8","series-title":"Acta Neurochir (Wien)","first-page":"1247","article-title":"Flow diverter for the treatment of large (>10 mm) vertebral artery dissecting aneurysms","volume":"164","author":"Lee","year":"2022","unstructured":"Lee WHan HJKim JFlow diverter for the treatment of large (>10 mm) vertebral artery dissecting aneurysms. Acta Neurochir (Wien). 2022;164(5):1247-1254."},{"key":"bib9","series-title":"Front Neurol","first-page":"748","article-title":"Unfavorable outcomes related to endovascular treatment of giant vertebrobasilar aneurysms","volume":"11","author":"Li","year":"2020","unstructured":"Li MLiang HWang J.Unfavorable outcomes related to endovascular treatment of giant vertebrobasilar aneurysms. Front Neurol. 2020;11:748."},{"key":"bib10","series-title":"Surg Neurol Int","first-page":"23","article-title":"Treatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus","volume":"14","author":"Yoshida","year":"2023","unstructured":"Yoshida SKamatani KMaruyama KTreatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus. Surg Neurol Int. 2023;14:23."},{"issue":"2","key":"bib11","series-title":"J Neurosurg","first-page":"407","article-title":"Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum: case report","volume":"98","author":"Iihara","year":"2003","unstructured":"Iihara KMurao KSakai NContinued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum: case report. J Neurosurg. 2003;98(2):407-413."},{"key":"bib12","series-title":"World Neurosurg","first-page":"368.e1","article-title":"Vasa vasorum and the growing of thrombosed giant aneurysm of the vertebral artery: a case report","volume":"85","author":"Pahl","year":"2016","unstructured":"Pahl FHVellutini Ede ACardoso ACde Oliveira MF.Vasa vasorum and the growing of thrombosed giant aneurysm of the vertebral artery: a case report. World Neurosurg. 2016;85:368.e1-368.e3684."},{"issue":"5","key":"bib13","series-title":"J Neurosurg","first-page":"796","article-title":"Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management","volume":"82","author":"Nagahiro","year":"1995","unstructured":"Nagahiro STakada AGoto SKai YUshio Y.Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg. 1995;82(5):796-801."},{"issue":"3","key":"bib14","series-title":"Neuroradiology","first-page":"266","article-title":"Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging","volume":"29","author":"Schubiger","year":"1987","unstructured":"Schubiger O, Valavanis A, Wichmann W. Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology. 1987;29(3):266-271."},{"issue":"14","key":"bib15","series-title":"J Neurosurg","article-title":"Partially thrombosed giant basilar artery aneurysm with attenuated contrast enhancement of the intraluminal thrombus on vessel wall MRI after flow diversion treatment: illustrative case","volume":"6","author":"Matsukawa","year":"2023","unstructured":"Matsukawa SIshii AFushimi YPartially thrombosed giant basilar artery aneurysm with attenuated contrast enhancement of the intraluminal thrombus on vessel wall MRI after flow diversion treatment: illustrative case. J Neurosurg. 2023;6(14)."},{"issue":"2","key":"bib16","series-title":"J Neurosurg","first-page":"161","article-title":"Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms: immediate results and long-term outcome in 201 patients","volume":"79","author":"Steinberg","year":"1993","unstructured":"Steinberg GKDrake CGPeerless SJ.Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms: immediate results and long-term outcome in 201 patients. J Neurosurg. 1993;79(2):161-173."},{"issue":"10","key":"bib17","series-title":"AJNR Am J Neuroradiol","first-page":"1827","article-title":"Flow diversion of posterior circulation aneurysms: systematic review of disaggregated individual patient data","volume":"42","author":"Alwakeal","year":"2021","unstructured":"Alwakeal AShlobin NAGolnari PFlow diversion of posterior circulation aneurysms: systematic review of disaggregated individual patient data. AJNR Am J Neuroradiol. 2021;42(10):1827-1833."},{"key":"bib18","series-title":"World Neurosurg","first-page":"403","article-title":"Augmenting occlusion outcomes through pipeline with adjunctive coiling","volume":"120","author":"Bender","year":"2018","unstructured":"Bender MTColby GPCoon AL.Augmenting occlusion outcomes through pipeline with adjunctive coiling. World Neurosurg. 2018;120:403-404."},{"key":"bib19","series-title":"Front Neurol","first-page":"728176","article-title":"Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation","volume":"12","author":"Tsunoda","year":"2021","unstructured":"Tsunoda SInoue T.Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation. Front Neurol. 2021;12:728176."},{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"132","article-title":"Occult rupture of a giant vertebral artery aneurysm following proximal occlusion and intrasaccular thrombosis: case report","volume":"95","author":"Piepgras","year":"2001","unstructured":"Piepgras DGKhurana VGNichols DA.Occult rupture of a giant vertebral artery aneurysm following proximal occlusion and intrasaccular thrombosis: case report. J Neurosurg. 2001;95(1):132-137."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"468","article-title":"Angiographically occult, progressively expanding, giant vertebral artery aneurysm: case report","volume":"105","author":"Komotar","year":"2006","unstructured":"Komotar RJMocco JLavine SDSolomon RA.Angiographically occult, progressively expanding, giant vertebral artery aneurysm: case report. J Neurosurg. 2006;105(3):468-471."},{"key":"bib3","series-title":"Ther Adv Neurol Disord","first-page":"17562864231176187","article-title":"Flow diversion for posterior circulation aneurysms: a multicenter retrospective study","volume":"16","author":"Qi","year":"2023","unstructured":"Qi PTong XLiang XFlow diversion for posterior circulation aneurysms: a multicenter retrospective study. Ther Adv Neurol Disord. 2023;16:17562864231176187."},{"issue":"3","key":"bib4","series-title":"J Neuropathol Exp Neurol","first-page":"409","article-title":"A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian hospital, 1914 to 1956","volume":"17","author":"Housepian","year":"958","unstructured":"Housepian EMPoot JL.A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian hospital, 1914 to 1956. J Neuropathol Exp Neurol. 958;17(3):409-423."},{"key":"bib5","series-title":"World Neurosurg","first-page":"e507","article-title":"Long-term outcome of endovascular therapy for large or giant thrombosed intracranial aneurysms","volume":"144","author":"Enomoto","year":"2020","unstructured":"Enomoto YEgashira YMatsubara HYoshimura SIwama T.Long-term outcome of endovascular therapy for large or giant thrombosed intracranial aneurysms. World Neurosurg. 2020;144:e507-e512."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e164","article-title":"Flow diversion for treatment of partially thrombosed aneurysms: a multicenter cohort","volume":"135","author":"Foreman","year":"2020","unstructured":"Foreman PMSalem MMGriessenauer CJFlow diversion for treatment of partially thrombosed aneurysms: a multicenter cohort. World Neurosurg. 2020;135:e164-e173."},{"issue":"4","key":"bib7","series-title":"Neuroradiol J","first-page":"365","article-title":"Endovascular treatment of cerebral aneurysms using flow-diverter devices: a systematic review","volume":"28","author":"Briganti","year":"2015","unstructured":"Briganti FLeone GMarseglia MEndovascular treatment of cerebral aneurysms using flow-diverter devices: a systematic review. Neuroradiol J. 2015;28(4):365-375."},{"issue":"5","key":"bib8","series-title":"Acta Neurochir (Wien)","first-page":"1247","article-title":"Flow diverter for the treatment of large (>10 mm) vertebral artery dissecting aneurysms","volume":"164","author":"Lee","year":"2022","unstructured":"Lee WHan HJKim JFlow diverter for the treatment of large (>10 mm) vertebral artery dissecting aneurysms. Acta Neurochir (Wien). 2022;164(5):1247-1254."},{"key":"bib9","series-title":"Front Neurol","first-page":"748","article-title":"Unfavorable outcomes related to endovascular treatment of giant vertebrobasilar aneurysms","volume":"11","author":"Li","year":"2020","unstructured":"Li MLiang HWang J.Unfavorable outcomes related to endovascular treatment of giant vertebrobasilar aneurysms. Front Neurol. 2020;11:748."},{"key":"bib10","series-title":"Surg Neurol Int","first-page":"23","article-title":"Treatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus","volume":"14","author":"Yoshida","year":"2023","unstructured":"Yoshida SKamatani KMaruyama KTreatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus. Surg Neurol Int. 2023;14:23."},{"issue":"2","key":"bib11","series-title":"J Neurosurg","first-page":"407","article-title":"Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum: case report","volume":"98","author":"Iihara","year":"2003","unstructured":"Iihara KMurao KSakai NContinued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum: case report. J Neurosurg. 2003;98(2):407-413."},{"key":"bib12","series-title":"World Neurosurg","first-page":"368.e1","article-title":"Vasa vasorum and the growing of thrombosed giant aneurysm of the vertebral artery: a case report","volume":"85","author":"Pahl","year":"2016","unstructured":"Pahl FHVellutini Ede ACardoso ACde Oliveira MF.Vasa vasorum and the growing of thrombosed giant aneurysm of the vertebral artery: a case report. World Neurosurg. 2016;85:368.e1-368.e3684."},{"issue":"5","key":"bib13","series-title":"J Neurosurg","first-page":"796","article-title":"Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management","volume":"82","author":"Nagahiro","year":"1995","unstructured":"Nagahiro STakada AGoto SKai YUshio Y.Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg. 1995;82(5):796-801."},{"issue":"3","key":"bib14","series-title":"Neuroradiology","first-page":"266","article-title":"Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging","volume":"29","author":"Schubiger","year":"1987","unstructured":"Schubiger O, Valavanis A, Wichmann W. Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology. 1987;29(3):266-271."},{"issue":"14","key":"bib15","series-title":"J Neurosurg","article-title":"Partially thrombosed giant basilar artery aneurysm with attenuated contrast enhancement of the intraluminal thrombus on vessel wall MRI after flow diversion treatment: illustrative case","volume":"6","author":"Matsukawa","year":"2023","unstructured":"Matsukawa SIshii AFushimi YPartially thrombosed giant basilar artery aneurysm with attenuated contrast enhancement of the intraluminal thrombus on vessel wall MRI after flow diversion treatment: illustrative case. J Neurosurg. 2023;6(14)."},{"issue":"2","key":"bib16","series-title":"J Neurosurg","first-page":"161","article-title":"Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms: immediate results and long-term outcome in 201 patients","volume":"79","author":"Steinberg","year":"1993","unstructured":"Steinberg GKDrake CGPeerless SJ.Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms: immediate results and long-term outcome in 201 patients. J Neurosurg. 1993;79(2):161-173."},{"issue":"10","key":"bib17","series-title":"AJNR Am J Neuroradiol","first-page":"1827","article-title":"Flow diversion of posterior circulation aneurysms: systematic review of disaggregated individual patient data","volume":"42","author":"Alwakeal","year":"2021","unstructured":"Alwakeal AShlobin NAGolnari PFlow diversion of posterior circulation aneurysms: systematic review of disaggregated individual patient data. AJNR Am J Neuroradiol. 2021;42(10):1827-1833."},{"key":"bib18","series-title":"World Neurosurg","first-page":"403","article-title":"Augmenting occlusion outcomes through pipeline with adjunctive coiling","volume":"120","author":"Bender","year":"2018","unstructured":"Bender MTColby GPCoon AL.Augmenting occlusion outcomes through pipeline with adjunctive coiling. World Neurosurg. 2018;120:403-404."},{"key":"bib19","series-title":"Front Neurol","first-page":"728176","article-title":"Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation","volume":"12","author":"Tsunoda","year":"2021","unstructured":"Tsunoda SInoue T.Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation. Front Neurol. 2021;12:728176."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25383.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25383.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25383.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:09:08Z","timestamp":1769684948000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25383.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":38,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/case25383","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]}}}