Nakau Hiroya, Nagatani Hitoshi, Nakau Reiko, Hanayama Hiroshi, Ametani Toshio
Department of Neurosurgery, Uji Tokushukai Hospital, 86 Kasugamori, Oguracho, Uji-shi, Kyoto, Japan.
No Shinkei Geka. 2007 Mar;35(3):267-72.
A 35-year-old female developed a subarachnoid hemorrhage from an aneurysm located at the fenestration of the vertebrobasilar (VB) junction. The patient was treated with Guglielmi detachable coils (GDCs). The aneurysm was successfully occluded using 8 coils despite the fact that 2 major complications occurred during the procedure: perforation of the aneurysm with a coil and thrombosis of the parent artery. The GDC that had perforated the aneurysm was left and remained partially in the subarachnoid space, and embolization was continued. The thrombus was mechanically crushed and dissolved. Forty days postoperatively, the patient was discharged home with minimal sequelae. VB junction fenestration is present in 35.5%-70% of VB junction aneurysms, but fenestration of the VB junction is sometimes overlooked on selective angiography. Careful pre-operative assessment is needed for aneurysms at the VB junction. The international subarachnoid aneurysm trial (ISAT) found that endovascular treatment was superior to surgery in the management of ruptured aneurysms. Nevertheless, thromboembolic complications and perforation are associated with coil embolization. Thus, care should be taken to avoid these complications, and it is indispensable to have appropriate treatment options immediately available to deal with them should they occur.
一名35岁女性因位于椎基底动脉（VB）交界处开窗处的动脉瘤发生蛛网膜下腔出血。该患者接受了 Guglielmi 可脱卸弹簧圈（GDC）治疗。尽管在手术过程中发生了2种主要并发症：弹簧圈致动脉瘤穿孔和载瘤动脉血栓形成，但仍使用8个弹簧圈成功闭塞了动脉瘤。已穿孔动脉瘤的GDC留在原位并部分残留于蛛网膜下腔，栓塞继续进行。血栓经机械破碎和溶解。术后40天，患者出院，后遗症轻微。35.5%-70%的VB交界处动脉瘤存在VB交界处开窗，但在选择性血管造影时，VB交界处开窗有时会被忽略。对于VB交界处的动脉瘤，术前需要仔细评估。国际蛛网膜下腔动脉瘤试验（ISAT）发现，在破裂动脉瘤的治疗中，血管内治疗优于手术治疗。然而，血栓栓塞并发症和穿孔与弹簧圈栓塞相关。因此，应注意避免这些并发症，并且必须立即具备适当的治疗方案，以便在并发症发生时进行处理。
