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I have a vertebral vessel problem and would like to seek some advice.
Two weeks ago, I have been diagnosed with vertebrate artery aneurysm.

I had an head ache in Oct 2014, had an CT an MR Scan then which reviewed a plaque in the distal end of the left vertebrate artery, and also suspected aneurysm (not obvious at that time). My neurologist told me to come back and do a CTA in 6 months. I did two weeks ago, which reviewed a "wide-neck aneurysm" at the same location, "consistent with the MR 7 months ago. I have seen a few neurologists and neurosurgeons in Hong Kong who advised to do an endovascular procedure to implant a Pipeline device, but I am trying to decide whether to do it or not due to risks of the procedure, and if I go ahead, which hospital/doctor would be more suitable.

I saw two some articles from Japan that suggest conservative treatment for this type of aneurysm. And another article from Canada that indicates high risks of intracranial hemorrhage, both aneurysmal and distant from the treated lesion, amounting to 0%–11% in variously reported series" and that "the consequences for these patients who are typically on dual antiplatelet therapy are often disastrous. This type of complication is particularly unsettling, given our uncertainty of the dangers of an unruptured aneurysm compared with its ruptured counterpart, even for large, giant, or irregular lesions."

I have had hypertension for over 10 years, taking Caduet: 10/20 mg, and normally controlled at 120 - 130/ 80 – 90. Also diabetes, taking Metformin: 500mg, twice daily. Last week added Nebilet: 2.5 mg to lower heart rate and better control blood pressure.

Category: Neurosurgeon

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Category: Spine Surgeon
Dr. Goutham Cugati is online now

Expert:  Dr. Goutham Cugati replied 4 Days.

Thank you for your query at DoctorSpring.com
I have seen and studied the scan and the reports sent by you...
Few information missing..
1. Are you on antiplatelets already
2. Where are you from

Answering your other quires....
This is definitely an Aneurysm. This can re-rupture anytime.
Endovascular treatment is a must. Pipeline stents are the preferred.
Risk of hemorrhage from a dual antiplatelet is less than a conservative treatment.
Age plays a major criterion for conservative treatment.
These types of aneurysms have relatively less complications compared to other aneurysms.
Before doing a endovascular treatment, they will definitely do a DSA.
best place would be Fujita university Japan. I don't know the doctors at HongKong.

With regard

Patient replied :

Hi thanks for your reply. I am not on anti plated yet but would need to if I decide on the pipeline procedure. I am from Hong Kong. From the images I sent can you tell clearly that this is an aneurysm? Is there a way for me to send to you the dicom files for a closer look? Thanks again.

Expert:  Dr. Goutham Cugati replied 3 Days.

What ever kind of intervention you may opt for, you have to be on anti platelet medications in future. The images sent by you definitely show an aneurysm. DSA will be done by the doctors before doing any intervention. I am not sure of any way by which you can send the dicom images. As mentioned before I am not really aware of the best interventional surgeons in Hong Kong.
With regards

Dr. Goutham Cugati
Category: Spine Surgeon
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
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