• Yuichi Kawasaki, Takashi Izumi, Masahiro Nishihori, Shunsaku Goto, Yoshio Araki, Kinya Yokoyama, and Ryuta Saito.
• Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
• Neurosurgery. 2024 Jul 15.

Background And ImportancePartially thrombosed vertebral artery aneurysms (PTVAs) are rare, most of which are not easy to treat. Furthermore, endovascular treatment of PTVAs may not have favorable outcomes. The relationship between PTVAs and well-developed vasa vasorum (VV), including the mechanism of aneurysm growth, has been reported, but there are no reports of imaging findings by digital subtraction angiography (DSA). In this case, we successfully performed superselective angiography of well-developed VV and evaluated its imaging characteristics. We present the first DSA report of a well-developed VV of PTVA.Clinical PresentationA 54-year-old patient presented with a PTVA that exerted a mass effect on the medulla oblongata. The aneurysm had no cavity due to thrombosis. The 3-dimensional DSA images indicated VV. Superselective angiography of the VV indicated staining of the thrombosed aneurysm and draining into the suboccipital cavernous sinus through the venous VV. Thus, VV embolization with n-butyl cyanoacrylate was performed. After 3 months, the contrast effect of the aneurysm on contrast-enhanced magnetic resonance imaging disappeared and aneurysm shrinkage was observed.ConclusionWe successfully identified a VV within PTVA. Superselective VV angiography showed staining of the thrombosed component and venous return draining into the suboccipital cavernous sinus. In this case, the embolization of the VV proved to be an effective endovascular treatment of PTVA, but the safety of this method is a challenge. Further case studies are required to validate this method, and we hope it will evolve into a new treatment of PTVA.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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