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Clinical significance of basilar artery aneurysms

In a postmortem review of 50 cases involving basilar artery aneurysms, we found that saccular and fusiform aneurysms have distinct clinicopathologic characteristics. Saccular aneurysms occur more often in younger age groups and in women, and fusiform lesions occur in older groups and in men. The saccular lesion usually is clinically silent until it ruptures, and rupture is the most common cause of death. Fusiform aneurysms generally occur in severely atherosclerotic basilar arteries; the cause of death most likely is atherosclerotic disease. Although the lesion is generally asymptomatic, it can produce symptoms and signs of vertebrobasilar occlusive disease, or it can rupture (with subarachnoid hemorrhage), or it can present as a mass effect, in that order of likelihood. The dual potential of the fusiforrn aneurysm to cause symptoms of vertebrobasilar insufficiency and to rupture is illustrated in one case.