Unlike saccular or berry aneurysms, which present more often with subarachnoid hemorrhage, fusiform aneurysms present more often with ischemic stroke or mass effect. The most time-tested treatment of fusiform vertebrobasilar aneurysms consists of flow reduction or flow reversal. Recently, flow diversion has been attempted with mixed results in the posterior circulation. Given the described pathophysiologic processes of fusiform aneurysms that may be altered with modern medical therapies, future investigators may look to medical treatment of these lesions, especially in cases of poor surgical candidates.
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