Post-embolisation flow disturbances at the basilar tip triggering the development of an arterial aneurysm. A case report.

SUMMARY: We present the case of an ll-year-old boy with a large intracerebral and intraventricular haemorrhage due to rupture of a left temporal arteriovenous malformation. The child initially presented with severe headaches and meningism, right VIth nerve palsy, right hemianopsia, and expressive aphasia. After stabilization of his neurological status, the patient was embolised in two sessions with acrylic glue (Histoacryl(*)), obliterating nearly 90% of the nidus, the residual to be considered for gamma-knife radiosurgery. The first session of embolisation had been complicated, during retrieval of the microcatheter, by an erratic embolus of glue in the basilar artery. The child was kept for 24 hours under heparin anticoagulation in order to avoid any thrombosis, followed by aspirin. His neurological examination remained stable without worsening of his clinical condition. Further angiographic controls demonstrated the patency of the basilar artery itself with remodelling changes at the basilar tip, with preservation of the perforators in this region. Secondary dilatation of the basilar tip with development of an arterial aneurysm was noted three years after the accident, pointing to the importance of flow turbulence and vascular wall weakness in the development of an arterial aneurysm. The clinical follow-up of this patient is 3.5 years; his neurological status is stable with hemianopsia, mild dysphasia and memory difficulties. Further follow-up will be needed in order to determine the therapeutic requirement for the arterial aneurysm.