Journal of neurosurgery. Case lessons最新文献_第3页

Ewing sarcoma of the sphenoid bone: illustrative case. 蝶骨尤文氏肉瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25427

Yousef Bassi, Rakan K Alhabib, Thamer Hamad Alsharif, Abdulhadi Y Algahtani

{"title":"Ewing sarcoma of the sphenoid bone: illustrative case.","authors":"Yousef Bassi, Rakan K Alhabib, Thamer Hamad Alsharif, Abdulhadi Y Algahtani","doi":"10.3171/CASE25427","DOIUrl":"10.3171/CASE25427","url":null,"abstract":"Background: Ewing sarcoma (ES) is a rare malignancy primarily affecting children and adolescents, with cranial involvement representing less than 1% of cases. The sphenoid bone is an exceptionally uncommon site, presenting diagnostic and therapeutic challenges due to its proximity to neurovascular structures.Observations: We present the case of a 19-year-old male diagnosed at the age of 13 with ES in the sphenoid bone, extending into the anterior cranial fossa and orbit. The patient initially received chemotherapy and radiotherapy, resulting in partial regression; however, the patient experienced disease progression and underwent resection. Postoperative recovery was complicated by osteomyelitis, which was resolved with antibiotics and wound debridement. One year postoperatively, the patient was neurologically intact with stable imaging findings. A systematic review of the literature was conducted to identify similar cases of sphenoid ES and highlight their outcomes.Lessons: ES of the sphenoid bone is a rare pathology that demands a high index of suspicion and a multidisciplinary treatment approach. Despite anatomical challenges, outcomes can be optimized through an aggressive multimodal therapy approach. Continued research is needed to establish standardized treatment protocols and improve long-term survival. https://thejns.org/doi/10.3171/CASE25427.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

White cord syndrome: a rare and challenging diagnosis. Illustrative case. 白索综合征：一种罕见且具有挑战性的诊断。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25542

Bekir Rovčanin, Ibrahim Omerhodžić, Amila Gadžo, Almir Džurlić, Haso Sefo, Adi Ahmetspahić, Edin Hajdarpašić, Kenan Arnautović

{"title":"White cord syndrome: a rare and challenging diagnosis. Illustrative case.","authors":"Bekir Rovčanin, Ibrahim Omerhodžić, Amila Gadžo, Almir Džurlić, Haso Sefo, Adi Ahmetspahić, Edin Hajdarpašić, Kenan Arnautović","doi":"10.3171/CASE25542","DOIUrl":"10.3171/CASE25542","url":null,"abstract":"Background: White cord syndrome (WCS) is a rare and extremely serious complication that can occur following spinal decompression procedures for severe mostly cervical spinal stenosis. It is often reported immediately after surgery or several hours to days postoperatively and is identified via a diagnosis of exclusion based on new-onset sudden motor weakness after a decompression procedure.Observations: The authors report the illustrative case of a 54-year-old female patient with WCS, who was managed with surgical intervention, corticosteroid therapy, and mean arterial blood pressure support. Additionally, the authors systematically reviewed an additional 27 cases of WCS documented in the literature.Lessons: A relatively favorable clinical outcome was observed in this patient following surgical intervention combined with corticosteroid therapy and mean blood pressure support. Currently, there are no established guidelines for the treatment of WCS; however, in any patient experiencing sudden neurological deterioration after cervical spinal decompressive surgery-especially when a known cause is unidentified-WCS should be considered as a potential diagnosis, and prompt treatment should be initiated to attempt to improve outcomes. https://thejns.org/doi/10.3171/CASE25542.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Repeat selective dorsal rhizotomy for residual spasticity: illustrative case. 重复选择性背根切断术治疗残余痉挛：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25433

Elizabeth Ledbetter, Aloysia L Schwabe, Heather Sgro, Sarah Slocum, Nisha Gadgil

引用次数: 0

Synchronous multiple meningiomas and renal cell carcinoma metastasis to the brain in a 68Ga-DOTATATE scan: illustrative case. 68Ga-DOTATATE扫描显示多发性脑膜瘤及肾细胞癌向脑部转移：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25527

Victor Goulenko, Venkatesh Shankar Madhugiri, Neil D Almeida, Rohil Shekher, Lindsay Lipinski, Robert J Plunkett, Dheerendra Prasad

{"title":"Synchronous multiple meningiomas and renal cell carcinoma metastasis to the brain in a 68Ga-DOTATATE scan: illustrative case.","authors":"Victor Goulenko, Venkatesh Shankar Madhugiri, Neil D Almeida, Rohil Shekher, Lindsay Lipinski, Robert J Plunkett, Dheerendra Prasad","doi":"10.3171/CASE25527","DOIUrl":"10.3171/CASE25527","url":null,"abstract":"Background: In the last few years, there has been an increased use of theragnostics for the detection of intracranial lesions. The use of 68Ga-DOTATATE has shown beneficial use for meningiomas, but it can pose a challenge when evaluating dura-based metastatic lesions.Observations: The authors describe the case of a 60-year-old patient with a confirmed diagnosis of renal cell carcinoma (RCC) that presented on brain MRI with two dura-based lesions and an intra-axial mass. All three lesions presented uptake on 68Ga-DOTATATE with different standardized uptake value (SUV) levels.Lessons: 68Ga-DOTATATE is highly sensitive for detecting benign and malignant CNS tumors, including small lesions. It aids in planning treatment, defining radiosurgical targets, and monitoring response. In RCC, it yields a higher SUV than 18F-fluorodeoxyglucose positron emission tomography, making it a more effective diagnostic tool. In meningiomas, the SUV correlates with tumor growth rate. However, specificity is limited, and interpretation requires correlation with MRI, CT, and clinical findings. As its use in CNS tumors grows, understanding its capabilities and limitations is crucial for proper application. https://thejns.org/doi/10.3171/CASE25527.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Awake prone lateral transpsoas lumbar interbody fusion with simultaneous posterior decompression and fusion: illustrative case. 清醒俯卧侧位经腰肌椎体间融合术同时后路减压融合：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25467

Christian Quinones, Wesley Jameson, Ryan Diaz, Enoch Kim, Deepak Kumbhare, Varsha Allampalli, Stanley Hoang

{"title":"Awake prone lateral transpsoas lumbar interbody fusion with simultaneous posterior decompression and fusion: illustrative case.","authors":"Christian Quinones, Wesley Jameson, Ryan Diaz, Enoch Kim, Deepak Kumbhare, Varsha Allampalli, Stanley Hoang","doi":"10.3171/CASE25467","DOIUrl":"10.3171/CASE25467","url":null,"abstract":"Background: Awake spine surgery under spinal anesthesia may reduce perioperative risk in older or medically complex patients. This report presents the first documented case of an awake, single-position prone lateral transpsoas interbody fusion at L3-4 with simultaneous posterior decompression and fusion to treat a 77-year-old male with neurogenic claudication and mechanical back pain. A technical approach was developed to complete the procedure within the approximate 3-hour duration of spinal anesthesia. Prone positioning enabled simultaneous access to lateral and posterior corridors. Intraoperative navigation, dual-surgeon coordination, and patient-specific anesthetic planning were used to streamline the workflow.Observations: The procedure was completed within the spinal anesthesia window without the need for conversion to general anesthesia. The patient remained hemodynamically stable and tolerated prone positioning. No lumbar plexus-related complications occurred, and both clinical and radiographic outcomes were favorable.Lessons: This case supports the feasibility of awake, single-position prone lateral lumbar interbody fusion with concurrent posterior decompression and fusion. It highlights key considerations for patient selection, anesthetic planning, and intraoperative coordination. Ongoing refinement of this technique may broaden its applicability in high-risk populations by balancing operative efficiency with the benefits of spinal anesthesia. https://thejns.org/doi/10.3171/CASE25467.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transcranial arterial coagulation with cardiac standstill after catastrophic frontopolar artery injury during endoscopic endonasal resection of tuberculum sellae meningioma: illustrative case. 鼻内窥镜切除鞍结节脑膜瘤时灾难性额极动脉损伤后经颅动脉凝血并心脏停止：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25281

Edmund John B Cayanong, Daniel I Tan, Angelo Augusto M Sumalde, Kenny S Seng, Gerardo D Legaspi, Arsenio Claro A Cabungcal, Juan Silvestre G Pascual

{"title":"Transcranial arterial coagulation with cardiac standstill after catastrophic frontopolar artery injury during endoscopic endonasal resection of tuberculum sellae meningioma: illustrative case.","authors":"Edmund John B Cayanong, Daniel I Tan, Angelo Augusto M Sumalde, Kenny S Seng, Gerardo D Legaspi, Arsenio Claro A Cabungcal, Juan Silvestre G Pascual","doi":"10.3171/CASE25281","DOIUrl":"10.3171/CASE25281","url":null,"abstract":"Background: Arterial injuries are among the most dangerous complications of endoscopic endonasal skull base surgery (EESBS), posing a risk of massive hemorrhage and requiring immediate management. Although uncommon, such events can be life-threatening. This report describes the first documented case of using a transcranial approach to control an arterial injury sustained during EESBS, with hemostasis achieved via bipolar diathermy.Observations: During endoscopic resection of a tuberculum sellae meningioma, profuse bleeding from the right frontopolar artery occurred. Initial control measures-large bore suction, hemostatic agents, and muscle packing-proved insufficient through the endonasal route. As an endovascular option was not available, a left pterional craniotomy was performed, where the lacerated artery was successfully coagulated. Simultaneously, endoscopic packing was maintained to limit ongoing hemorrhage. The procedure lasted 10 hours 40 minutes, with a total blood loss of 5 L. The patient survived the event but experienced worsened vision.Lessons: This case underscores the severity of arterial injuries during EESBS and the importance of prompt, adaptable management. Core mitigation strategies include early recognition, precise localization of the bleeding vessel, aggressive packing, and timely conversion to an alternative approach, such as a transcranial route, when endonasal control fails. https://thejns.org/doi/10.3171/CASE25281.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimal stimulation of the thalamic centromedian nucleus in children with Lennox-Gastaut syndrome: patient series. lenox - gastaut综合征患儿丘脑中央核的最佳刺激：患者系列。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25478

Aaron E L Warren, Audrey Xu, Maria Isabel Barros Guinle, Thomas Johnstone, Prathyusha Teeyagura, Rayann Solidum, Ann Hyslop, Hyunmi Kim, Gerald Grant, Jonathon J Parker, Vivek Buch, Brenda E Porter, Juliet K Knowles

{"title":"Optimal stimulation of the thalamic centromedian nucleus in children with Lennox-Gastaut syndrome: patient series.","authors":"Aaron E L Warren, Audrey Xu, Maria Isabel Barros Guinle, Thomas Johnstone, Prathyusha Teeyagura, Rayann Solidum, Ann Hyslop, Hyunmi Kim, Gerald Grant, Jonathon J Parker, Vivek Buch, Brenda E Porter, Juliet K Knowles","doi":"10.3171/CASE25478","DOIUrl":"10.3171/CASE25478","url":null,"abstract":"Background: Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple seizure types, intellectual disability, and distinctive EEG findings. Deep brain stimulation of the centromedian nucleus (CM-DBS) is an emerging therapy for LGS, but pediatric experience remains limited.Observations: The authors report a single-center experience with CM-DBS in 6 children and adolescents (ages 12-18 years) with LGS. One patient experienced infection-related device removal after 2 months. The remaining 5 received sustained stimulation for 2.5-5 years. All 5 showed caregiver-reported improvements in seizure burden and alertness, with corroborating Clinical Global Impression-Improvement scores. Three patients exhibited marked seizure reduction following targeted reprogramming toward a previously identified optimal target of stimulation in the anterolateral CM. Pre- and post-DBS scalp EEG recordings were available in 1 patient and showed a reduced burden of interictal discharges.Lessons: CM-DBS is a promising treatment for pediatric, medically refractory LGS when resective approaches are unsuitable. Benefits were sustained over years. Lead localization and direction of stimulation appear important to optimize clinical benefit. These findings support the feasibility and safety of pediatric CM-DBS and highlight the need for prospective trials incorporating EEG-based outcomes and patient-centered measures including comorbidities and quality of life. Early, network-targeted neuromodulation may improve long-term outcomes. https://thejns.org/doi/10.3171/CASE25478.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Primary abdominal manifestations of vagus nerve stimulation: illustrative case. 迷走神经刺激的主要腹部表现：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25117

Noah M Yaffe, Eric Z Herring, Kerrin S Sunshine, Krystal L Tomei

{"title":"Primary abdominal manifestations of vagus nerve stimulation: illustrative case.","authors":"Noah M Yaffe, Eric Z Herring, Kerrin S Sunshine, Krystal L Tomei","doi":"10.3171/CASE25117","DOIUrl":"10.3171/CASE25117","url":null,"abstract":"Background: Vagus nerve stimulation (VNS) is a neuromodulation option for seizure control in intractable epilepsy. Commonly reported side effects of VNS include manifestations of vagus nerve dysfunction, such as cough, hoarseness, and neck pain. While some patients experience transient nausea and vomiting, more significant gastrointestinal (GI) symptoms have not yet been described in the literature.Observations: The patient is a 13-year-old female with type 4 early infantile epileptic encephalopathy who underwent placement of a left-sided VNS system for treatment of medically refractory epilepsy. After initiation of VNS, she developed abdominal pain, worsened constipation, decreased oral intake progressing to complete oral aversion, and urinary retention. The VNS device was turned off after 6 months, leading to resolution of the listed symptoms.Lessons: Review of this patient's symptoms highlights two ways that VNS may affect vagal signaling: disruption of pain modulation pathways and aberrant stimulation leading to GI dysmotility. Prior studies of the vagus nerve topography reveal heterogeneity in the layout of fascicles, which are unaccounted for with the current surgical technique. Recognition of the potential association of VNS with this uncommon collection of symptoms is important for surgeons offering this treatment. https://thejns.org/doi/10.3171/CASE25117.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is there an optimal sequencing of endoscopic third ventriculostomy and stereotactic radiosurgery for brain metastasis with secondary obstructive hydrocephalus? Illustrative case. 对于继发性梗阻性脑积水脑转移患者，是否有内镜下第三脑室造瘘和立体定向放射手术的最佳顺序？说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25275

Victor Goulenko, Venkatesh Shankar Madhugiri, Neil D Almeida, Rohil Shekher, Andrew J Fabiano, Dheerendra Prasad

{"title":"Is there an optimal sequencing of endoscopic third ventriculostomy and stereotactic radiosurgery for brain metastasis with secondary obstructive hydrocephalus? Illustrative case.","authors":"Victor Goulenko, Venkatesh Shankar Madhugiri, Neil D Almeida, Rohil Shekher, Andrew J Fabiano, Dheerendra Prasad","doi":"10.3171/CASE25275","DOIUrl":"10.3171/CASE25275","url":null,"abstract":"Background: Secondary hydrocephalus caused by tumor obstruction of the aqueduct leads to anatomical distortion of the third ventricle (3V) and the surrounding structures. This report quantifies and discusses the dosimetric impact of hydrocephalus in stereotactic radiosurgery (SRS) treatment and discusses the optimal sequencing between radiosurgery and endoscopic third ventriculostomy (ETV).Observations: The authors review a case of intracranial metastasis causing secondary obstructive hydrocephalus that underwent ETV before SRS. Dual SRS plans were made based on the MRI before and after the ETV to evaluate the impact of the ventricular volume on dosimetry. Both plans had the same treatment parameters. The time interval between the MRI studies was approximately 20 days, with a 74% increase in the tumor size. The post-ETV plan revealed a reduced ventricular volume, particularly the 3V, with a noticeable shift in normal brain structures, leading them to receive increased doses.Lessons: The anatomical changes caused by the ventricular reduction after the ETV associated with the tumor growth were enough to produce a higher dose to the healthy tissue, exposing the patient to a greater risk of adverse radiation effects. Shortening the interval between ETV and SRS can minimize anatomical shifts and the risk of adverse effects while maintaining adequate patient management. https://thejns.org/doi/10.3171/CASE25275.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment pitfalls in recurrent dolichoectatic basilar trunk aneurysm with flow diversion: illustrative case. 复发性扩张性基底干动脉瘤伴血流分流的治疗误区：一例说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-22 DOI: 10.3171/CASE25131

Mikaeel A Habib, Aaron Anandarajah, Luis O Tierradentro-Garcia, Jaeha Kim, Omar A Choudhri

{"title":"Treatment pitfalls in recurrent dolichoectatic basilar trunk aneurysm with flow diversion: illustrative case.","authors":"Mikaeel A Habib, Aaron Anandarajah, Luis O Tierradentro-Garcia, Jaeha Kim, Omar A Choudhri","doi":"10.3171/CASE25131","DOIUrl":"10.3171/CASE25131","url":null,"abstract":"Background: Intracranial arterial dolichoectasia (IADE), also known as dilative arteriopathy, is a vascular disorder characterized by arterial elongation, dilation, and tortuosity, predominantly affecting the vertebrobasilar system. Fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar system are a rare but challenging subset of aneurysms associated with IADE, exhibiting a high recurrence rate and limited treatment options. Flow diversion has emerged as an endovascular treatment approach for managing these aneurysms, although it does come with significant risks.Observations: A 54-year-old patient presented with a large fusiform basilar trunk aneurysm (BTA) secondary to IADE and underwent flow diversion with Pipeline embolization devices. Despite initial stabilization, the aneurysm recurred multiple times over several years, requiring additional flow diversion procedures. The patient later developed hydrocephalus, necessitating placement of a ventriculoperitoneal shunt, which was complicated by a basilar artery thrombus and ischemic stroke requiring thrombectomy. Long-term follow-up revealed ongoing aneurysm remodeling and persistent symptoms.Lessons: This case highlights the challenges of managing recurrent dolichoectatic BTAs with flow diversion, the importance of long-term surveillance, and the risk of complications, including hydrocephalus and ischemic events, following intervention. Individualized treatment strategies are essential to mitigate complications and optimize outcomes. https://thejns.org/doi/10.3171/CASE25131.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0