Cukurova Medical Journal Cukurova Med J 2017;42(2):373-375 ÇUKUROVA ÜNİVERSİTESİ TIP FAKÜLTESİ DERGİSİ DOI: 10.17826/cutf.323070 Yazışma Adresi/Address for Correspondence: Dr. Mehmet Seçer Osmangazi mah. 14 nolu Cadde 162/1 Şehitkamil Gaziantep, Turkey E-mail: memetsecer@yahoo.com Geliş tarihi/Received: 06.08.2016 Kabul tarihi/Accepted: 10.09.2016 OLGU SUNUMU / CASE REPORT Multilobuled high basilar artery aneurysm causing hydrocephalus Yüksek yerleşimli multilobüle baziller arter anevrizmasına bağlı hidrosefali Murat Ulutaş 1 ,Mehmet Seçer 2 1 Sanko University Konukoglu Hospital Department of Neurosurgery, Gaziantep, Turkey 2 Ersin Arslan Training and Research Hospital, Department of Neurosurgery, Gaziantep, Turkey Cukurova Medical Journal 2017;42(2):373-375 Abstract Öz This report describes an obstructive hydrocephalus caused by the mass effect of a basilar artery aneurysm which is a rare condition. A giant multilobed aneurysm that developed in the high basilar tip causing hydrocephalus was treated successfully through clipping and lamina terminalis fenestration. The method of treating hydrocephalus caused by aneurysm is controversial. Ventriculoperitoneal shunt and endoscopic third ventriculostomy are among treatment options. Microsurgical clipping and lamina terminalis fenestration of a high basilar tip aneurysm causing hydrocephalus is a safe and effective method for treating both aneurysm and hydrocephalus in appropriate patients. Bu yazıda nadir bir durum olan basiller arter anevrizmasının kitle etkisinin yol açtığı obstrüktif hidrosefalili bir olgu bildirilmiştir. Hidrosefaliye yol açmış yüksek yerleşimli basiller tepe de gelişen dev multilobüle anevrizma, klipleme ve lamina terminalis fenstrasyonu ile başarılı bir şekilde tedavi edilmiştir. Anevrizmaya bağlı gelişen hidrosefali tedavisinin yönetimi tartışmalıdır. Ventriculoperitoneal shunt ve endoskopik third ventrikülostomi tedavi seçenekleri arasındadır. Hidrosefaliye yol açan yüksek yerleşimli basiller tepe anevrizmasının mikroşirürjikal olarak anevrizmanın klipajı ve lamina terminalis fenestrasyonu hem anevrizma hem de hidrosefali tedavisinde en güvenli ve fizyolojik yöntemdir. Key words: basilar artery aneurysm, hydrocephalus, microsurgery. Anahtar kelimeler: Baziller arter anevrizması, hidrosefli, microcerrahi. INTRODUCTION Basilar artery aneurysm is not very common, 5-8% of all intracranial aneurysms are located by the basilar artery bifurcation 1 . The symptoms and findings of a basilar artery aneurysm depend on the occlusion of the parent artery and perforators, rupturing of aneurysm or mass effect 2,3 . The obstructive hydrocephalus caused by the mass effect of a basilar artery aneurysm is a rare condition. The choice for treating this hydrocephalus caused byaneurysm is controversial. The ventriculoperitoneal (VP) shunt procedure may lead to bleeding in or widening of aneurysm. Although the endoscopic third ventriculostomy is the ideal treatment option, it has the disadvantage of technical difficulty in the presence of th hydrocephalus with basilar tip aneurysms 2-4 . We explain in this report how a giant multilobed ruptured aneurysm that developed in the high- location basilar tip causing hydrocephalus was treated successfully through clipping and lamina terminalis fenestration. CASE A female patient aged 73 who complained headache and sudden blackout was hospitalized after being diagnosed with Fisher grade 4 subarachnoid hemorrhage (SAH) and acute hydrocephalus on the computed tomography (CT). The patient who was Glasgow Coma Scale (GCS) grade was 12 (E2, V5, M5) and Hunt&Hess grade 3 was stabilized hemodynamically in the intensive care unit and was