{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:04Z","timestamp":1776096364263,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"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":[[2026,3,23]]},"abstract":"\n BACKGROUND<\/jats:title>\n Fusiform aneurysms of the distal basilar artery are challenging, with high morbidity and mortality. Brainstem perforating vessels, the lack of an aneurysm neck, critical anatomical location near the brainstem, and progression to a large size make any treatment difficult. They are usually treated in an elective planned setting. An acute rupture poses extra challenges. Treatment options are surgical or endovascular. Endovascular treatments have revolved around flow diversion, although given the irregular lumen, this is difficult. Open microsurgical techniques center around bypass and parent vessel occlusion.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 54-year-old man was admitted to the authors\u2019 hospital 4 days after experiencing a subarachnoid hemorrhage from a distal basilar fusiform aneurysm. The rupture point was clipped acutely. The aneurysm rupture point recurred quickly and required definitive treatment of the parent fusiform aneurysm with bypass and parent artery clipping.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case illustrates challenging decision-making in the management of an acute subarachnoid hemorrhage from a complex aneurysm. The case was managed surgically with early treatment of the acute rupture and planned later definitive treatment of the parent aneurysm. Endovascular options are also discussed.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25895<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25895","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:00Z","timestamp":1775642640000},"source":"Crossref","is-referenced-by-count":0,"title":["Treatment strategies for subarachnoid hemorrhage in a distal basilar dolichoectatic aneurysm: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Yosuke","family":"Suzuki","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Otaru Central Hospital, Otaru, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3955-6749","authenticated-orcid":true,"given":"Nick","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"J Clin Neurosci","first-page":"111027","article-title":"Two types of arteriopathies, arteriomegaly and aneurysms, frequently develop at diverse locations in vertebrobasilar dolichoectasia patients: a retrospective analysis and a meta-analysis","volume":"133","author":"Shimizu","year":"2025","unstructured":"Shimizu KTani SFukumitsu RTwo types of arteriopathies, arteriomegaly and aneurysms, frequently develop at diverse locations in vertebrobasilar dolichoectasia patients: a retrospective analysis and a meta-analysis. J Clin Neurosci. 2025;133:111027. doi:10.1016\/j.jocn.2024.111027"},{"issue":"4","key":"bib2","series-title":"AJNR Am J Neuroradiol","first-page":"727","article-title":"Variable porosity of the pipeline embolization device in straight and curved vessels: a guide for optimal deployment strategy","volume":"35","author":"Shapiro","year":"2014","unstructured":"Shapiro MRaz EBecske TNelson PK.Variable porosity of the pipeline embolization device in straight and curved vessels: a guide for optimal deployment strategy. AJNR Am J Neuroradiol. 2014;35(4):727-733. doi:10.3174\/ajnr.a3742"},{"issue":"6","key":"bib3","series-title":"J Neurosurg","first-page":"1258","article-title":"Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms","volume":"116","author":"Siddiqui","year":"2012","unstructured":"Siddiqui AHAbla AAKan PPanacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms. J Neurosurg. 2012;116(6):1258-1266. doi:10.3171\/2012.2.jns111942"},{"key":"bib4","series-title":"Front Surg","first-page":"1603876","article-title":"Case report: \u201cStent-within-a-stent\u201d technique after telescopic flow diverter reconstruction for basilar artery aneurysm with proximal stenosis","volume":"12","author":"Mammadinova","year":"2025","unstructured":"Mammadinova INurimanov CNurakay NMenlibayeva KAkshulakov SMakhambetov Y.Case report: \u201cStent-within-a-stent\u201d technique after telescopic flow diverter reconstruction for basilar artery aneurysm with proximal stenosis. Front Surg. 2025;12:1603876. doi:10.3389\/fsurg.2025.1603876"},{"issue":"7","key":"bib5","series-title":"AJNR Am J Neuroradiol","first-page":"1346","article-title":"Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms: a report on periprocedural course and long-term follow-up","volume":"35","author":"Ertl","year":"2014","unstructured":"Ertl LHoltmannsp\u00f6tter MPatzig MBr\u00fcckmann HFesl G.Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms: a report on periprocedural course and long-term follow-up. AJNR Am J Neuroradiol. 2014;35(7):1346-1352. doi:10.3174\/ajnr.a3859"},{"issue":"1","key":"bib18","series-title":"J Neurosurg","first-page":"111","article-title":"The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center","volume":"125","author":"Natarajan","year":"2016","unstructured":"Natarajan SKLin NSonig AThe safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center. J Neurosurg. 2016;125(1):111-119. doi:10.3171\/2015.6.jns1565"},{"issue":"4","key":"bib6","series-title":"J Neurosurg","first-page":"500","article-title":"Aneurysms of the basilar artery trunk","volume":"66","author":"Sugita","year":"1987","unstructured":"Sugita KKobayashi STakemae TTada TTanaka Y.Aneurysms of the basilar artery trunk. J Neurosurg. 1987;66(4):500-505. doi:10.3171\/jns.1987.66.4.0500"},{"issue":"4","key":"bib7","series-title":"J Neurosurg","first-page":"436","article-title":"The surgical treatment of aneurysms of the basilar artery","volume":"29","author":"Drake","year":"1968","unstructured":"Drake CG.The surgical treatment of aneurysms of the basilar artery. J Neurosurg. 1968;29(4):436-446. doi:10.3171\/jns.1968.29.4.0436"},{"issue":"4","key":"bib8","series-title":"Surg Cereb Stroke","first-page":"259","article-title":"Anterior temporal approach for basilar bifurcation aneurysms as a modified distal transsylvian approach","volume":"26","author":"Tanikawa","year":"1998","unstructured":"Tanikawa RWada HIshizaki TAnterior temporal approach for basilar bifurcation aneurysms as a modified distal transsylvian approach. Surg Cereb Stroke. 1998;26(4):259-264. doi:10.2335\/scs1987.26.4_259"},{"issue":"1","key":"bib9","series-title":"Surg Neurol Int","first-page":"10","article-title":"A modified anterior temporal approach for low-position aneurysms of the upper basilar complex","volume":"6","author":"Katsuno","year":"2015","unstructured":"Katsuno MTanikawa RIzumi NHashimoto M.A modified anterior temporal approach for low-position aneurysms of the upper basilar complex. Surg Neurol Int. 2015;6(1):10. doi:10.4103\/2152-7806.149843"},{"key":"bib10","series-title":"World Neurosurg","first-page":"490","article-title":"Technical description of the medial and lateral anterior temporal approach for the treatment of complex proximal posterior cerebral artery aneurysms","volume":"86","author":"Goehre","year":"2016","unstructured":"Goehre FKamiyama HNoda KTechnical description of the medial and lateral anterior temporal approach for the treatment of complex proximal posterior cerebral artery aneurysms. World Neurosurg. 2016;86:490-496. doi:10.1016\/j.wneu.2015.09.068"},{"issue":"1","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"55","article-title":"High-resolution computed tomography of the basilar artery: 1. Normal size and position","volume":"7","author":"Smoker","year":"1986","unstructured":"Smoker WRPrice MJKeyes WDCorbett JJGentry LR.High-resolution computed tomography of the basilar artery: 1. Normal size and position. AJNR Am J Neuroradiol. 1986;7(1):55-60."},{"issue":"5","key":"bib12","series-title":"AJNR Am J Neuroradiol","first-page":"915","article-title":"Clinical and imaging characteristics of diffuse intracranial dolichoectasia","volume":"38","author":"Brinjikji","year":"2017","unstructured":"Brinjikji WNasr DMFlemming KDClinical and imaging characteristics of diffuse intracranial dolichoectasia. AJNR Am J Neuroradiol. 2017;38(5):915-922. doi:10.3174\/ajnr.a5102"},{"key":"bib13","series-title":"Brain Spine","first-page":"103333","article-title":"Review of current treatment modalities and clinical outcome of giant saccular aneurysms of the basilar apex","volume":"4","author":"Theofanopoulos","year":"2024","unstructured":"Theofanopoulos ATroude LNeyazi MMuhammad S.Review of current treatment modalities and clinical outcome of giant saccular aneurysms of the basilar apex. Brain Spine. 2024;4:103333. doi:10.1016\/j.bas.2024.103333"},{"issue":"1-2","key":"bib14","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. doi:10.1159\/000486866"},{"issue":"5","key":"bib15","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. doi:10.3171\/2023.2.focus22650"},{"issue":"1","key":"bib16","series-title":"Neurosurgery","first-page":"82","article-title":"Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction\u2014clinicopathological 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\u2014clinicopathological and surgical outcome. Neurosurgery. 2020;88(1):82-95. doi:10.1093\/neuros\/nyaa317"},{"key":"bib1","series-title":"J Clin Neurosci","first-page":"111027","article-title":"Two types of arteriopathies, arteriomegaly and aneurysms, frequently develop at diverse locations in vertebrobasilar dolichoectasia patients: a retrospective analysis and a meta-analysis","volume":"133","author":"Shimizu","year":"2025","unstructured":"Shimizu KTani SFukumitsu RTwo types of arteriopathies, arteriomegaly and aneurysms, frequently develop at diverse locations in vertebrobasilar dolichoectasia patients: a retrospective analysis and a meta-analysis. J Clin Neurosci. 2025;133:111027. doi:10.1016\/j.jocn.2024.111027"},{"issue":"4","key":"bib2","series-title":"AJNR Am J Neuroradiol","first-page":"727","article-title":"Variable porosity of the pipeline embolization device in straight and curved vessels: a guide for optimal deployment strategy","volume":"35","author":"Shapiro","year":"2014","unstructured":"Shapiro MRaz EBecske TNelson PK.Variable porosity of the pipeline embolization device in straight and curved vessels: a guide for optimal deployment strategy. AJNR Am J Neuroradiol. 2014;35(4):727-733. doi:10.3174\/ajnr.a3742"},{"issue":"6","key":"bib3","series-title":"J Neurosurg","first-page":"1258","article-title":"Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms","volume":"116","author":"Siddiqui","year":"2012","unstructured":"Siddiqui AHAbla AAKan PPanacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms. J Neurosurg. 2012;116(6):1258-1266. doi:10.3171\/2012.2.jns111942"},{"key":"bib4","series-title":"Front Surg","first-page":"1603876","article-title":"Case report: \u201cStent-within-a-stent\u201d technique after telescopic flow diverter reconstruction for basilar artery aneurysm with proximal stenosis","volume":"12","author":"Mammadinova","year":"2025","unstructured":"Mammadinova INurimanov CNurakay NMenlibayeva KAkshulakov SMakhambetov Y.Case report: \u201cStent-within-a-stent\u201d technique after telescopic flow diverter reconstruction for basilar artery aneurysm with proximal stenosis. Front Surg. 2025;12:1603876. doi:10.3389\/fsurg.2025.1603876"},{"issue":"7","key":"bib5","series-title":"AJNR Am J Neuroradiol","first-page":"1346","article-title":"Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms: a report on periprocedural course and long-term follow-up","volume":"35","author":"Ertl","year":"2014","unstructured":"Ertl LHoltmannsp\u00f6tter MPatzig MBr\u00fcckmann HFesl G.Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms: a report on periprocedural course and long-term follow-up. AJNR Am J Neuroradiol. 2014;35(7):1346-1352. doi:10.3174\/ajnr.a3859"},{"issue":"1","key":"bib18","series-title":"J Neurosurg","first-page":"111","article-title":"The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center","volume":"125","author":"Natarajan","year":"2016","unstructured":"Natarajan SKLin NSonig AThe safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center. J Neurosurg. 2016;125(1):111-119. doi:10.3171\/2015.6.jns1565"},{"issue":"4","key":"bib6","series-title":"J Neurosurg","first-page":"500","article-title":"Aneurysms of the basilar artery trunk","volume":"66","author":"Sugita","year":"1987","unstructured":"Sugita KKobayashi STakemae TTada TTanaka Y.Aneurysms of the basilar artery trunk. J Neurosurg. 1987;66(4):500-505. doi:10.3171\/jns.1987.66.4.0500"},{"issue":"4","key":"bib7","series-title":"J Neurosurg","first-page":"436","article-title":"The surgical treatment of aneurysms of the basilar artery","volume":"29","author":"Drake","year":"1968","unstructured":"Drake CG.The surgical treatment of aneurysms of the basilar artery. J Neurosurg. 1968;29(4):436-446. doi:10.3171\/jns.1968.29.4.0436"},{"issue":"4","key":"bib8","series-title":"Surg Cereb Stroke","first-page":"259","article-title":"Anterior temporal approach for basilar bifurcation aneurysms as a modified distal transsylvian approach","volume":"26","author":"Tanikawa","year":"1998","unstructured":"Tanikawa RWada HIshizaki TAnterior temporal approach for basilar bifurcation aneurysms as a modified distal transsylvian approach. Surg Cereb Stroke. 1998;26(4):259-264. doi:10.2335\/scs1987.26.4_259"},{"issue":"1","key":"bib9","series-title":"Surg Neurol Int","first-page":"10","article-title":"A modified anterior temporal approach for low-position aneurysms of the upper basilar complex","volume":"6","author":"Katsuno","year":"2015","unstructured":"Katsuno MTanikawa RIzumi NHashimoto M.A modified anterior temporal approach for low-position aneurysms of the upper basilar complex. Surg Neurol Int. 2015;6(1):10. doi:10.4103\/2152-7806.149843"},{"key":"bib10","series-title":"World Neurosurg","first-page":"490","article-title":"Technical description of the medial and lateral anterior temporal approach for the treatment of complex proximal posterior cerebral artery aneurysms","volume":"86","author":"Goehre","year":"2016","unstructured":"Goehre FKamiyama HNoda KTechnical description of the medial and lateral anterior temporal approach for the treatment of complex proximal posterior cerebral artery aneurysms. World Neurosurg. 2016;86:490-496. doi:10.1016\/j.wneu.2015.09.068"},{"issue":"1","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"55","article-title":"High-resolution computed tomography of the basilar artery: 1. Normal size and position","volume":"7","author":"Smoker","year":"1986","unstructured":"Smoker WRPrice MJKeyes WDCorbett JJGentry LR.High-resolution computed tomography of the basilar artery: 1. Normal size and position. AJNR Am J Neuroradiol. 1986;7(1):55-60."},{"issue":"5","key":"bib12","series-title":"AJNR Am J Neuroradiol","first-page":"915","article-title":"Clinical and imaging characteristics of diffuse intracranial dolichoectasia","volume":"38","author":"Brinjikji","year":"2017","unstructured":"Brinjikji WNasr DMFlemming KDClinical and imaging characteristics of diffuse intracranial dolichoectasia. AJNR Am J Neuroradiol. 2017;38(5):915-922. doi:10.3174\/ajnr.a5102"},{"key":"bib13","series-title":"Brain Spine","first-page":"103333","article-title":"Review of current treatment modalities and clinical outcome of giant saccular aneurysms of the basilar apex","volume":"4","author":"Theofanopoulos","year":"2024","unstructured":"Theofanopoulos ATroude LNeyazi MMuhammad S.Review of current treatment modalities and clinical outcome of giant saccular aneurysms of the basilar apex. Brain Spine. 2024;4:103333. doi:10.1016\/j.bas.2024.103333"},{"issue":"1-2","key":"bib14","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. doi:10.1159\/000486866"},{"issue":"5","key":"bib15","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. doi:10.3171\/2023.2.focus22650"},{"issue":"1","key":"bib16","series-title":"Neurosurgery","first-page":"82","article-title":"Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction\u2014clinicopathological 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\u2014clinicopathological and surgical outcome. Neurosurgery. 2020;88(1):82-95. doi:10.1093\/neuros\/nyaa317"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25895.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25895.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25895.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:25:39Z","timestamp":1776093939000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25895.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,23]]},"references-count":34,"journal-issue":{"issue":"12"},"URL":"https:\/\/doi.org\/10.3171\/case25895","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,23]]}}}