• Richard F Schmidt, Ahmad Sweid, Nohra Chalouhi, Michael B Avery, Kalyan C Sajja, Fadi Al-Saiegh, Joshua H Weinberg, Ashlee Asada, Daniel Joffe, Hekmat K Zarzour, M Reid Gooch, Robert H Rosenwasser, Pascal M Jabbour, and Stavropoula I Tjoumakaris.
• Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: Richard.f.schmidt@Jefferson.edu.
• World Neurosurg. 2021 Feb 1; 146: e607-e617.

BackgroundAneurysms associated with fenestrations of intracranial arteries are exceptionally rare findings. Management strategies for these aneurysms are not well-defined, especially regarding endovascular treatment. We sought to investigate the strategies and feasibility of endovascular treatment approaches for various fenestration-associated intracranial aneurysms.MethodsWe performed a retrospective chart review of 2000 aneurysms treated endovascularly, identifying 8 aneurysms located at arterial fenestrations. The technical details and procedural outcomes were reviewed to identify common management approaches, technical nuances, and treatment outcomes.ResultsThere were 3 (37.5%) aneurysms associated with fenestrations of the basilar artery or vertebrobasilar junction. All 3 were successfully treated with a previously undescribed coil-assisted flow-diversion technique, resulting in complete obliteration. Three (37.5%) aneurysms were associated with fenestrations of the anterior communicating artery. Of those, 2 were successfully treated with stent-assisted coil embolization and 1 with coil embolization alone. One (12.5%) aneurysm was associated with a fenestration of the paraclinoid internal carotid artery and 1 (12.5%) aneurysm found was at the takeoff of the posterior inferior cerebellar artery at a fenestration of the vertebral artery. Both were successfully treated with coil-assisted flow diversion. There were no permanent procedural complications. Major considerations for endovascular management of these aneurysms were the dominance of fenestration trunks, aneurysms arising from the fenestration apex or a fenestration limb, amenability to flow diversion, and anticipation of vascular remodeling.ConclusionsFenestration-associated aneurysms are very rare. We have identified common factors to help guide decision-making for endovascular approaches and demonstrate successful aneurysm treatment using these methods.Copyright © 2020 Elsevier Inc. All rights reserved.

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