{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:37:08Z","timestamp":1769726228907,"version":"3.49.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"25","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"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":[[2025,12,22]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Early intracerebral hematoma (ICH) expansion without aneurysm rerupture is extremely rare in patients with a ruptured basilar artery perforator aneurysm (BAPA), and the treatment strategy has not been established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 47-year-old male was rushed to the authors\u2019 hospital due to loss of consciousness. CT imaging showed diffuse subarachnoid hemorrhage (SAH) and ventriculomegaly, and 3D CT angiography (CTA) showed a BAPA. Ventricular drainage was performed, and conservative treatment for the BAPA was started. However, CT imaging on SAH day 1 showed an enlarged ICH in the right temporal lobe with no increase of SAH. Subsequent CTA showed no contrast extravasation from the right middle cerebral artery and no detection of BAPA. Since the BAPA was not considered to have reruptured and there was no mass effect due to the ICH, conservative treatment was continued with close imaging studies. There was no rerupture of the BAPA, and ventriculoperitoneal shunt insertion was performed on SAH day 36. The patient was transferred to a rehabilitation hospital on SAH day 62 with a modified Rankin Scale score of 1 (mild attention disorder).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Conservative management for a ruptured BAPA can be performed even in a case of early ICH enlargement without aneurysm rerupture.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25760\">https:\/\/thejns.org\/doi\/10.3171\/CASE25760<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25760","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:59:55Z","timestamp":1769083195000},"source":"Crossref","is-referenced-by-count":0,"title":["Successful conservative management for ruptured basilar artery perforator aneurysm associated with early hematoma expansion in right temporal lobe without aneurysm rerupture: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4467-3358","authenticated-orcid":true,"given":"Hideki","family":"Nakajima","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Matsusaka Chuo General Hospital, Matsusaka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Matsusaka Chuo General Hospital, Matsusaka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3813-9847","authenticated-orcid":true,"given":"Tetsushi","family":"Yago","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Matsusaka Chuo General Hospital, Matsusaka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiko","family":"Tsuda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Matsusaka Chuo General Hospital, Matsusaka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8555-5448","authenticated-orcid":true,"given":"Hidenori","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Neurosurgery","first-page":"393","article-title":"Distal basilar perforator artery aneurysm: case report","volume":"39","author":"Ghogawala","year":"1996","unstructured":"Ghogawala ZShumacher JMOgilvy CS.Distal basilar perforator artery aneurysm: case report. Neurosurgery. 1996;39(2):393-396."},{"issue":"5","key":"bib2","series-title":"Neuroradiology","first-page":"639","article-title":"Comparison between stenting and conservative management of posterior circulation perforator aneurysms: systematic review and case series","volume":"63","author":"Gardijan","year":"2021","unstructured":"Gardijan DHerega TPremu\u017ei\u0107 VComparison between stenting and conservative management of posterior circulation perforator aneurysms: systematic review and case series. Neuroradiology. 2021;63(5):639-651."},{"key":"bib3","series-title":"Surg Neurol Int","first-page":"498","article-title":"Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: a case report","volume":"12","author":"Nakajima","year":"2021","unstructured":"Nakajima HTsuchiya TShimizu SSuzuki H.Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: a case report. Surg Neurol Int. 2021;12:498."},{"issue":"3","key":"bib4","series-title":"NMC Case Rep J","first-page":"93","article-title":"Ruptured basilar artery perforator aneurysm: a case report and review of the literature","volume":"7","author":"Enomoto","year":"2020","unstructured":"Enomoto NShinno KTamura TShikata EShono KTakase K.Ruptured basilar artery perforator aneurysm: a case report and review of the literature. NMC Case Rep J. 2020;7(3):93-100."},{"issue":"5","key":"bib5","series-title":"J Neurosurg","first-page":"1107","article-title":"Spontaneous resolution of perforator aneurysms of the posterior circulation","volume":"121","author":"Chavent","year":"2014","unstructured":"Chavent ALefevre PHThouant PSpontaneous resolution of perforator aneurysms of the posterior circulation. J Neurosurg. 2014;121(5):1107-1111."},{"issue":"1","key":"bib6","series-title":"Acta Neurochir (Wien)","first-page":"332","article-title":"Primary decompressive craniectomy in patients with large intracerebral hematomas due to aneurysmal subarachnoid hemorrhage","volume":"166","author":"Wenz","year":"2024","unstructured":"Wenz FZiebart AHackenberg KAMRinkel GJEEtminan NAbdulazim A.Primary decompressive craniectomy in patients with large intracerebral hematomas due to aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien). 2024;166(1):332."},{"key":"bib7","series-title":"Crit Care","first-page":"21","article-title":"The critical care management of poor-grade subarachnoid haemorrhage","volume":"20","author":"de Oliveira Manoel","year":"2016","unstructured":"de Oliveira Manoel ALGoffi AMarotta TRSchweizer TAAbrahamson SMacdonald RL.The critical care management of poor-grade subarachnoid haemorrhage. 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Surg Neurol Int. 2021;12:571."},{"key":"bib15","series-title":"Front Surg","first-page":"852576","article-title":"Delayed progressive mass effect after secured ruptured middle cerebral artery aneurysm: risk factors and outcomes","volume":"9","author":"Li","year":"2022","unstructured":"Li YCChen CCChen CTDelayed progressive mass effect after secured ruptured middle cerebral artery aneurysm: risk factors and outcomes. Front Surg. 2022;9:852576."},{"issue":"3","key":"bib16","series-title":"Neurol Med Chir (Tokyo)","first-page":"227","article-title":"Emerging sylvian subpial hematoma after the repair of the ruptured anterior cerebral artery aneurysm with interhemispheric approach: case report","volume":"54","author":"Minami","year":"2014","unstructured":"Minami NKimura TIchikawa YMorita A.Emerging sylvian subpial hematoma after the repair of the ruptured anterior cerebral artery aneurysm with interhemispheric approach: case report. Neurol Med Chir (Tokyo). 2014;54(3):227-230."},{"issue":"5","key":"bib17","series-title":"J Neurosurg","first-page":"1003","article-title":"Ultra-early endovascular embolization of ruptured cerebral aneurysm and the increased risk of hematoma growth unrelated to aneurysmal rebleeding","volume":"118","author":"Egashira","year":"2013","unstructured":"Egashira YYoshimura SEnomoto YIshiguro MAsano TIwama T.Ultra-early endovascular embolization of ruptured cerebral aneurysm and the increased risk of hematoma growth unrelated to aneurysmal rebleeding. J Neurosurg. 2013;118(5):1003-1008."},{"issue":"2","key":"bib18","series-title":"J Cerebrovasc Sci","first-page":"113","article-title":"Diagnosis and treatment of basilar artery perforator aneurysm: a 20-year review with proposed treatment guidelines","volume":"8","author":"Ganapathy","year":"2020","unstructured":"Ganapathy SLingaraju TS.Diagnosis and treatment of basilar artery perforator aneurysm: a 20-year review with proposed treatment guidelines. J Cerebrovasc Sci. 2020;8(2):113-122."},{"issue":"12","key":"bib19","series-title":"Acta Neurochir (Wien)","first-page":"1283","article-title":"Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment","volume":"147","author":"Hamel","year":"2005","unstructured":"Hamel WGrzyska UWestphal MKehler U.Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir (Wien). 2005;147(12):1283-1286."},{"issue":"2","key":"bib20","series-title":"Neurochirurgie","first-page":"101544","article-title":"Ruptured basilar artery perforator aneurysm mimicking superior cerebellar artery aneurysm","volume":"70","author":"Shin","year":"2024","unstructured":"Shin JELee JY.Ruptured basilar artery perforator aneurysm mimicking superior cerebellar artery aneurysm. Neurochirurgie. 2024;70(2):101544."},{"issue":"3","key":"bib21","series-title":"Clin Neuroradiol","first-page":"783","article-title":"Flow diverter treatment of ruptured basilar artery perforator aneurysms: a multicenter experience","volume":"32","author":"Elsheikh","year":"2022","unstructured":"Elsheikh SM\u00f6hlenbruch MSeker FFlow diverter treatment of ruptured basilar artery perforator aneurysms: a multicenter experience. Clin Neuroradiol. 2022;32(3):783-789."},{"issue":"6","key":"bib22","series-title":"Neurosurgery","first-page":"E697","article-title":"Treatment of a basilar trunk perforator aneurysm with the pipeline embolization device: case report","volume":"74","author":"Chalouhi","year":"2014","unstructured":"Chalouhi NJabbour PStarke RMTreatment of a basilar trunk perforator aneurysm with the pipeline embolization device: case report. Neurosurgery. 2014;74(6):E697-701."},{"issue":"1","key":"bib23","series-title":"Acta Neurochir (Wien)","first-page":"68","article-title":"Decompressive craniectomy in aneurysmal subarachnoid hemorrhage: can favorable outcome be achieved?","volume":"167","author":"Svedung Wettervik","year":"2025","unstructured":"Svedung Wettervik TCorell ASunila MDecompressive craniectomy in aneurysmal subarachnoid hemorrhage: can favorable outcome be achieved? Acta Neurochir (Wien). 2025;167(1):68."},{"issue":"2","key":"bib1","series-title":"Neurosurgery","first-page":"393","article-title":"Distal basilar perforator artery aneurysm: case report","volume":"39","author":"Ghogawala","year":"1996","unstructured":"Ghogawala ZShumacher JMOgilvy CS.Distal basilar perforator artery aneurysm: case report. Neurosurgery. 1996;39(2):393-396."},{"issue":"5","key":"bib2","series-title":"Neuroradiology","first-page":"639","article-title":"Comparison between stenting and conservative management of posterior circulation perforator aneurysms: systematic review and case series","volume":"63","author":"Gardijan","year":"2021","unstructured":"Gardijan DHerega TPremu\u017ei\u0107 VComparison between stenting and conservative management of posterior circulation perforator aneurysms: systematic review and case series. Neuroradiology. 2021;63(5):639-651."},{"key":"bib3","series-title":"Surg Neurol Int","first-page":"498","article-title":"Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: a case report","volume":"12","author":"Nakajima","year":"2021","unstructured":"Nakajima HTsuchiya TShimizu SSuzuki H.Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: a case report. Surg Neurol Int. 2021;12:498."},{"issue":"3","key":"bib4","series-title":"NMC Case Rep J","first-page":"93","article-title":"Ruptured basilar artery perforator aneurysm: a case report and review of the literature","volume":"7","author":"Enomoto","year":"2020","unstructured":"Enomoto NShinno KTamura TShikata EShono KTakase K.Ruptured basilar artery perforator aneurysm: a case report and review of the literature. NMC Case Rep J. 2020;7(3):93-100."},{"issue":"5","key":"bib5","series-title":"J Neurosurg","first-page":"1107","article-title":"Spontaneous resolution of perforator aneurysms of the posterior circulation","volume":"121","author":"Chavent","year":"2014","unstructured":"Chavent ALefevre PHThouant PSpontaneous resolution of perforator aneurysms of the posterior circulation. J Neurosurg. 2014;121(5):1107-1111."},{"issue":"1","key":"bib6","series-title":"Acta Neurochir (Wien)","first-page":"332","article-title":"Primary decompressive craniectomy in patients with large intracerebral hematomas due to aneurysmal subarachnoid hemorrhage","volume":"166","author":"Wenz","year":"2024","unstructured":"Wenz FZiebart AHackenberg KAMRinkel GJEEtminan NAbdulazim A.Primary decompressive craniectomy in patients with large intracerebral hematomas due to aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien). 2024;166(1):332."},{"key":"bib7","series-title":"Crit Care","first-page":"21","article-title":"The critical care management of poor-grade subarachnoid haemorrhage","volume":"20","author":"de Oliveira Manoel","year":"2016","unstructured":"de Oliveira Manoel ALGoffi AMarotta TRSchweizer TAAbrahamson SMacdonald RL.The critical care management of poor-grade subarachnoid haemorrhage. Crit Care. 2016;20:21."},{"issue":"11","key":"bib8","series-title":"Stroke","first-page":"2592","article-title":"Early intracerebral hematoma expansion after aneurysmal rupture","volume":"41","author":"van Asch","year":"2010","unstructured":"van Asch CJJOudendijk JFRinkel GJEKlijn CJM.Early intracerebral hematoma expansion after aneurysmal rupture. Stroke. 2010;41(11):2592-2595."},{"issue":"5","key":"bib9","series-title":"Neurochirurgie","first-page":"263","article-title":"A dissecting aneurysm of a basilar perforating artery","volume":"62","author":"Aboukais","year":"2016","unstructured":"Aboukais RZairi FEstrade LQuidet MLeclerc XLejeune JP.A dissecting aneurysm of a basilar perforating artery. Neurochirurgie. 2016;62(5):263-265."},{"key":"bib10","series-title":"NMC Case Rep J","first-page":"213","article-title":"Two cases of subarachnoid hemorrhage with microaneurysmal changes and spontaneous disappearance in the basilar artery","volume":"11","author":"Hagihara","year":"2024","unstructured":"Hagihara RArai HYamada SHirose S.Two cases of subarachnoid hemorrhage with microaneurysmal changes and spontaneous disappearance in the basilar artery. NMC Case Rep J. 2024;11:213-219."},{"key":"bib11","series-title":"J Clin Neurosci","first-page":"122","article-title":"Basilar artery perforator aneurysms: report of 9 cases and review of the literature","volume":"63","author":"Bhogal","year":"2019","unstructured":"Bhogal PAlMatter MHellstern VBasilar artery perforator aneurysms: report of 9 cases and review of the literature. J Clin Neurosci. 2019;63:122-129."},{"issue":"3","key":"bib12","series-title":"Brain Hemorrhages","first-page":"138","article-title":"Coexistence of ruptured basilar artery perforator aneurysm undetected on initial angiogram and unruptured anterior cerebral artery saccular aneurysm: case report and literature review","volume":"6","author":"Nakajima","year":"2025","unstructured":"Nakajima HSato YYago TTsuda KSuzuki H.Coexistence of ruptured basilar artery perforator aneurysm undetected on initial angiogram and unruptured anterior cerebral artery saccular aneurysm: case report and literature review. Brain Hemorrhages. 2025;6(3):138-141."},{"issue":"6","key":"bib13","series-title":"Neurosurgery","first-page":"1088","article-title":"Subarachnoid hemorrhage and intracerebral hematoma: incidence, prognostic factors, and outcome","volume":"63","author":"G\u00fcresir","year":"2008","unstructured":"G\u00fcresir EBeck JVatter HSubarachnoid hemorrhage and intracerebral hematoma: incidence, prognostic factors, and outcome. Neurosurgery. 2008;63(6):1088-93."},{"key":"bib14","series-title":"Surg Neurol Int","first-page":"571","article-title":"Hematoma expansion unrelated to rebleeding in ruptured anterior cerebral artery aneurysms treated by early endovascular embolization","volume":"12","author":"Okamura","year":"2021","unstructured":"Okamura KMorofuji YHorie NHematoma expansion unrelated to rebleeding in ruptured anterior cerebral artery aneurysms treated by early endovascular embolization. Surg Neurol Int. 2021;12:571."},{"key":"bib15","series-title":"Front Surg","first-page":"852576","article-title":"Delayed progressive mass effect after secured ruptured middle cerebral artery aneurysm: risk factors and outcomes","volume":"9","author":"Li","year":"2022","unstructured":"Li YCChen CCChen CTDelayed progressive mass effect after secured ruptured middle cerebral artery aneurysm: risk factors and outcomes. Front Surg. 2022;9:852576."},{"issue":"3","key":"bib16","series-title":"Neurol Med Chir (Tokyo)","first-page":"227","article-title":"Emerging sylvian subpial hematoma after the repair of the ruptured anterior cerebral artery aneurysm with interhemispheric approach: case report","volume":"54","author":"Minami","year":"2014","unstructured":"Minami NKimura TIchikawa YMorita A.Emerging sylvian subpial hematoma after the repair of the ruptured anterior cerebral artery aneurysm with interhemispheric approach: case report. Neurol Med Chir (Tokyo). 2014;54(3):227-230."},{"issue":"5","key":"bib17","series-title":"J Neurosurg","first-page":"1003","article-title":"Ultra-early endovascular embolization of ruptured cerebral aneurysm and the increased risk of hematoma growth unrelated to aneurysmal rebleeding","volume":"118","author":"Egashira","year":"2013","unstructured":"Egashira YYoshimura SEnomoto YIshiguro MAsano TIwama T.Ultra-early endovascular embolization of ruptured cerebral aneurysm and the increased risk of hematoma growth unrelated to aneurysmal rebleeding. J Neurosurg. 2013;118(5):1003-1008."},{"issue":"2","key":"bib18","series-title":"J Cerebrovasc Sci","first-page":"113","article-title":"Diagnosis and treatment of basilar artery perforator aneurysm: a 20-year review with proposed treatment guidelines","volume":"8","author":"Ganapathy","year":"2020","unstructured":"Ganapathy SLingaraju TS.Diagnosis and treatment of basilar artery perforator aneurysm: a 20-year review with proposed treatment guidelines. J Cerebrovasc Sci. 2020;8(2):113-122."},{"issue":"12","key":"bib19","series-title":"Acta Neurochir (Wien)","first-page":"1283","article-title":"Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment","volume":"147","author":"Hamel","year":"2005","unstructured":"Hamel WGrzyska UWestphal MKehler U.Surgical treatment of a basilar perforator aneurysm not accessible to endovascular treatment. Acta Neurochir (Wien). 2005;147(12):1283-1286."},{"issue":"2","key":"bib20","series-title":"Neurochirurgie","first-page":"101544","article-title":"Ruptured basilar artery perforator aneurysm mimicking superior cerebellar artery aneurysm","volume":"70","author":"Shin","year":"2024","unstructured":"Shin JELee JY.Ruptured basilar artery perforator aneurysm mimicking superior cerebellar artery aneurysm. Neurochirurgie. 2024;70(2):101544."},{"issue":"3","key":"bib21","series-title":"Clin Neuroradiol","first-page":"783","article-title":"Flow diverter treatment of ruptured basilar artery perforator aneurysms: a multicenter experience","volume":"32","author":"Elsheikh","year":"2022","unstructured":"Elsheikh SM\u00f6hlenbruch MSeker FFlow diverter treatment of ruptured basilar artery perforator aneurysms: a multicenter experience. 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