Conservative Management and Natural History of Ruptured Basilar Perforator Artery Aneurysms: Two Cases and Literature Review.

Background: Basilar perforator aneurysms are rare causes of subarachnoid hemorrhage and their natural history is poorly characterized. Although various treatment strategies have been reported, conservative management is an option that has been associated with a high likelihood of spontaneous resolution.

Case Description: Here we present 2 cases of subarachnoid hemorrhage, 1 diffuse and the other perimesencephalic, due to small ruptured basilar perforator artery aneurysms. These aneurysms were only identified after repeat angiography. Conservative management with serial imaging was pursued. Both patients did well clinically and repeat imaging demonstrated spontaneous resolution of the ruptured aneurysms. We also provide a literature review of ruptured basilar perforator aneurysms, showing a ~10% re-rupture rate within the early post-rupture period but otherwise a high rate of spontaneous resolution.

Conclusions: Although basilar perforator aneurysms can re-rupture, there is also a high likelihood of spontaneous resolution. Given the challenges of treatment, conservative management is an option that can be considered.