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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2018 Feb 23

DOI: 10.23736/S0390-5616.18.04225-X


language: English

Intracranial aneurysms of the posterior circulation associated with a fenestration: a systematic review

Carmelo L. STURIALE , Vito STIFANO, Giuseppe M. DELLA PEPA, Alessio ALBANESE, Eduardo FERNANDEZ, Enrico MARCHESE, Alfredo PUCA, Giovanni SABATINO, Alessandro OLIVI

Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy


INTRODUCTION: A fenestration is an anatomical variation that most commonly involves vessels of the posterior circulation, which can predispose the formation of aneurysms and represents a further technical challenge for treatment. There are no large series and the incidence of complications is unknown. This paper is a systematic review on this topic. EVIDENCE ACQUISITION: The relevant English literature was reviewed and the data was extracted for each patient and collected in a pool. Demographics, localization of fenestration, morphology and aneurysm topography, admission and follow-up clinical status, treatments, complications and occlusion rate were recorded.
EVIDENCE SYNTHESIS: We analyzed 62 articles published between 1992 and 2016 including 120/133 patients/aneurysms. The most commonly involved segment was the vertebro-basilar junction (82.5%), followed by the basilar trunk (10%). About 96.6% of reported aneurysms were saccular and 80.3% were ruptured. The preferred treatment was endovascular (86.67%) and a surgical clipping was reported in just over 13% of patients. A complete/almost complete occlusion was obtained in about 80% of cases, with a global rate of complications of 12.5%. A serious clinical condition at onset has been independently associated with poor outcome at multivariate analysis (P<.001).
CONCLUSIONS: This systematic review has shown that endovascular occlusion is the treatment of choice for posterior circulation aneurysms associated with fenestrations, being highly effective, with an occlusion rate of about 80%, unchanged at follow-up. Although he presence of a fenestration can make more complex the aneurysm occlusion, and the occurrence of complications is not negligible, it is not considered a limiting condition for treatment.

KEY WORDS: Fenestration - Intracranial aneurysms - Posterior circulation - Vertebro-basilar system - Endovascular treatment - Clipping

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Publication History

Article first published online: February 23, 2018
Manuscript accepted: January 25, 2018
Manuscript received: September 27, 2017

Cite this article as

Sturiale CL, Stifano V, Della Pepa GM, Albanese A, Fernandez E, Marchese E et al. Intracranial aneurysms of the posterior circulation associated with a fenestration: a systematic review. J Neurosurg Sci 2018 Feb 23. DOI: 10.23736/S0390-5616.18.04225-X

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