Albanese Erminia, Russo Antonino, Ulm Arthur J
Georgia Neurosurgical Institute, Mercer University School of Medicine, Macon, Georgia 31201, USA.
J Neurosurg. 2009 Mar;110(3):525-9. doi: 10.3171/2008.9.JNS08170.
Vertebrobasilar junction (VBJ) aneurysms are uncommon and are often found in association with basilar artery (BA) fenestration. The complex anatomical environment of the VBJ, and the complicated geometry of the fenestration make clipping of these aneurysms difficult. Therefore, endovascular treatment of these aneurysms is now widely accepted. The authors describe the case of a 43-year-old woman with sickle cell anemia. She presented with subarachnoid hemorrhage. Digital subtraction angiography was performed and depicted multiple intracranial aneurysms. The patient had a left superior hypophysial artery aneurysm, a right superior cerebellar artery-posterior cerebral artery aneurysm, and a VBJ aneurysm associated with a fenestration of the BA. The VBJ aneurysm was not identified on the initial angiogram and was only revealed after 3D rotational angiography was performed. The 3D reconstruction was critical to the understanding of the complex geometry associated with the fenestrated BA. The VBJ was reconstructed using a combination endovascular technique. The dominant limb of the fenestration was stented and balloon-assisted coiling was performed, followed by sacrifice of the nondominant vertebral artery using coils and the embolic agent Onyx. Postoperative angiography demonstrated successful occlusion of the aneurysm with reconstruction of the VBJ. To the authors' knowledge, this is the first report of a fenestrated VBJ aneurysm treated with the combination of stenting, balloon remodeling, coiling, and vessel sacrifice. Three-dimensional angiography was critical in making the correct diagnosis of the source of the subarachnoid hemorrhage and with operative planning.
椎基底动脉交界区（VBJ）动脉瘤并不常见，常与基底动脉（BA）开窗畸形相关。VBJ复杂的解剖环境以及开窗畸形复杂的几何形态使得这些动脉瘤的夹闭手术颇具难度。因此，目前这些动脉瘤的血管内治疗已被广泛接受。作者描述了一名患有镰状细胞贫血的43岁女性病例。她因蛛网膜下腔出血就诊。进行了数字减影血管造影，显示出多个颅内动脉瘤。该患者有一个左侧垂体上动脉动脉瘤、一个右侧小脑上动脉 - 大脑后动脉动脉瘤以及一个与BA开窗畸形相关的VBJ动脉瘤。初始血管造影未发现VBJ动脉瘤，仅在进行三维旋转血管造影后才得以显示。三维重建对于理解与开窗BA相关的复杂几何形态至关重要。采用联合血管内技术重建VBJ。对开窗的优势分支进行支架置入并实施球囊辅助弹簧圈栓塞，随后使用弹簧圈和栓塞剂Onyx闭塞非优势椎动脉。术后血管造影显示动脉瘤成功闭塞且VBJ得以重建。据作者所知，这是首例采用支架置入、球囊重塑、弹簧圈栓塞及血管闭塞联合治疗开窗型VBJ动脉瘤的报告。三维血管造影对于正确诊断蛛网膜下腔出血的来源及手术规划至关重要。
