Delayed posterior tilting of a giant basilar tip aneurysm following stent-assisted coiling with therapeutic P1 occlusion: A case report.

Authors

Hidemoto Fujiwara, Hitoshi Hasegawa, Tomoaki Suzuki, Makoto Oishi

Published in

Surgical neurology international. Volume 17. Pages 514. Epub Sep 11, 2026.

Abstract

Giant basilar tip aneurysms remain difficult to treat due to their location, bifurcation anatomy, adjacent perforators, and potential for mass effect. Endovascular treatment, including stent-assisted coiling, is a valuable option. Despite angiographic occlusion, mass effect may still be clinically significant.
A 67-year-old man presented with headache and was diagnosed with a 27 × 17-mm giant unruptured basilar tip aneurysm. Preoperative angiography demonstrated perforators arising predominantly from the left P1 segment and a well-developed right posterior communicating artery (PComA), while the left PComA was hypoplastic. Stent-assisted coiling was performed with stent placement from the basilar artery to the left posterior cerebral artery and occlusion of the non-stented right P1 segment. The early postoperative course was uneventful. Posterior tilting of the coiled aneurysm was first noted 1 week after treatment and subsequently progressed. Approximately 3 months after treatment, mass effect resulted in midbrain compression and obstructive hydrocephalus. Skull radiographs in different body positions demonstrated posture-dependent displacement of the coil mass, suggesting a role of gravity. Levodopa administration and ventriculoperitoneal shunting resulted in partial symptomatic improvement. Angiographic follow-up through 3 years demonstrated stable occlusion without recurrence, with no substantial progression of posterior tilting after the first postoperative year.
Stent-assisted coiling with therapeutic P1 occlusion may contribute to durable angiographic occlusion in selected giant basilar tip aneurysms. However, delayed posterior tilting of the coiled aneurysm may occur as a postoperative phenomenon. This potential delayed complication, leading to mass effect, should therefore be considered in treatment strategy and postoperative follow-up.

PMID:
42829652
Bibliographic data and abstract were imported from PubMed on 04 Oct 2026.

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