Abstract
Giant fusiform aneurysm of the vertebral artery is not common and is usually associated with thrombosis due to swirling blood flow, and manifests as mass effect on the medullary region with slow progression of neurological sign and symptoms. Trapping and ligation combined with bypass surgery, endovascular surgery, and proximal occlusion and flow diverter placement have been described; however, the optimal treatment is still debatable. A 35-year-old female presented to us with complaints of mild occipital headache, moderate pain over the right side of the nape region, numbness, and tingling sensation transferring to the right upper shoulder for 1 month. Magnetic resonance imaging (MRI) of cervical spine and brain revealed normal cervical spine. Brain MRI and digital subtraction angiography were done that revealed an almost completely thrombosed giant fusiform aneurysm of the V4 segment of the vertebral artery. Patient underwent endovascular therapy with complete coils packing. Postoperative status went uneventful. She was discharged on the 7th day of procedure. Complete occlusion of thrombosed giant fusiform V4 segment vertebral artery aneurysm by endovascular therapy with coils embolization is safe and effective.