• Felix Hendrik Pahl, Eduardo de Arnaldo Silva Vellutini, Alberto Carlos Capel Cardoso, and Matheus Fernandes de Oliveira.
• Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, Iamspe, São Paulo, Brazil; DFV Neuro, São Paulo, Brazil.
• World Neurosurg. 2016 Jan 1; 85: 368.e1-4.

BackgroundGiant aneurysms arising from the vertebral artery (VA) are often associated with thrombosis and present as mass lesions with slow progression of symptoms and signs. A consensus is still to be established on the underlying growth mechanisms and surgical management of thrombosed giant aneurysms of the VA.Case DescriptionHere, we report the case of a 54-year-old man who sought neurosurgical care after 3 months of progressive cervical axial pain. He underwent cervical magnetic resonance imaging and cerebral angiography, which revealed a giant VA aneurysm with thrombosed component. After failure of proximal and distal endovascular treatment, it was decided to adopt a surgical approach, which revealed a markedly developed vasa vasorum in the aneurysmal walls, raising the possibility of intra-aneurysmal nutrition from vasa vasorum. The patient recovered progressively and almost completely after surgery.ConclusionsAnother report described the case of a 58-year-old woman harboring a partially thrombosed giant aneurysm of the VA. At the time of resection, a marked development of vasa vasorum on the occluded VA and the neck of the aneurysm was noted. We highlight the need to comprehend vasa vasorum as potential sources for aneurysmal growth.Copyright © 2016 Elsevier Inc. All rights reserved.

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