Yu Jinlu, Xu Kan, Wang Honglei, Wang Bai, Luo Qi
Jilin University First Hospital, Department of Neurosurgery, Changchun, China.
Turk Neurosurg. 2012;22(4):483-8. doi: 10.5137/1019-5149.JTN.3830-10.0.
Isolated dissection of the basilar artery (BA) is rare and still a big challenge regarding treatment. The suitable therapeutic strategies for dissection of the BA remain controversial. We report the case of a young patient with a giant unruptured dissection of the BA successfully treated by endovascular coil embolization. A 14-year-old male who underwent computed tomography (CT) scan following a minor head trauma was incidentally found to have a lesion located anterior to brain stem. Further imaging with magnetic resonance imaging (MRI), computed tomography angiography (CTA) and digital subtraction angiography (DSA) were consistent with a diagnosis of giant unruptured dissection of the BA. The patient was initially observed conservatively. The follow-up DSA obtained 3 months later revealed extension of the dissection inferiorly to involve the left VA. The dissection expanded at the conjunction of VAs in the shape of ball. Therefore, coil embolization to occlude BA at the bottom of aneurysm was performed as a further treatment. Follow-up DSA 6 months later demonstrated complete obliteration of the dissection and good compensative perfusion from extensively collateral circulation. For young patients with isolated dissection of the BA, coil embolization to occlude BA at the bottom of aneurysm might be tolerable and effective.
孤立性基底动脉（BA）夹层罕见，其治疗仍是一大挑战。BA夹层的合适治疗策略仍存在争议。我们报告一例年轻患者，其巨大未破裂BA夹层经血管内弹簧圈栓塞成功治疗。一名14岁男性在轻微头部外伤后接受计算机断层扫描（CT）时，偶然发现脑干前方有一病变。进一步的磁共振成像（MRI）、计算机断层血管造影（CTA）和数字减影血管造影（DSA）检查结果均符合巨大未破裂BA夹层的诊断。患者最初接受保守观察。3个月后进行的随访DSA显示夹层向下延伸累及左椎动脉（VA）。夹层在椎动脉汇合处呈球状扩展。因此，作为进一步治疗，对动脉瘤底部的BA进行了弹簧圈栓塞以闭塞该血管。6个月后的随访DSA显示夹层完全闭塞，广泛的侧支循环实现了良好的代偿灌注。对于孤立性BA夹层的年轻患者，在动脉瘤底部对BA进行弹簧圈栓塞可能是可耐受且有效的。
