A Case of Unruptured Basilar-Superior Cerebellar Artery Aneurysm Successfully Treated with Preoperative 3D Silicone Model Simulation for Optimal Woven EndoBridge Device Implantation.

Abstract

Objective: The Woven EndoBridge (WEB), an intrasaccular device, is a new alternative to coils for the endovascular treatment of wide-neck bifurcation aneurysms. Selection of the correct size of the device is of utmost importance for successful treatment outcomes. We present a case of an unruptured cerebellar artery aneurysm that was successfully treated with WEB implantation, guided by a 3D silicone model for preoperative evaluation.

Case presentation: A 67-year-old woman with no family history of cerebral aneurysms was diagnosed with an unruptured basilar-superior cerebellar artery (BA-SCA) aneurysm. The patient's aneurysm was wide-necked with a dome of 8.1 mm, a neck of 6.5 mm, a height of 6.9 mm, and a volume of 287 mm³. In the preoperative simulation with 3D printed models, the WEB 9 × 4 mm device successfully preserved the SCA. Therefore, it was selected for treatment. Although the aneurysm had an angle of nearly 90° to the BA artery, the preoperative evaluation made it easy to guide the microcatheter and place the WEB device. The postoperative course was favorable and no new neurological symptoms were noted. Cerebral angiography performed 6 months after the procedure confirmed complete occlusion of the aneurysm.

Conclusion: Preoperative simulation with 3D printed models can help to plan device size selection and implantation position, thereby predicting intraoperative microcatheter behavior in advance.