Smoker W R, Corbett J J, Gentry L R, Keyes W D, Price M J, McKusker S
AJNR Am J Neuroradiol. 1986 Jan-Feb;7(1):61-72.
To better define the clinical significance of vertebrobasilar dolichoectasia, the clinical signs and symptoms and basilar artery parameters of diameter, height, and transverse position were evaluated in two groups of symptomatic patients. Ten patients had isolated involvement of the third, sixth, or seventh cranial nerves. The other 10 patients had multiple neurologic deficits including combinations of compressive cranial nerve deficits, both ischemic and compressive central nervous system deficits, and hydrocephalus. Although significant differences for mean basilar artery diameter and height exist between these two groups, the symptomatology and basilar artery parameters present as a spectrum. A symptomatic patient with a normal-caliber, but tortuous, basilar artery is more likely to have isolated cranial nerve involvement. Conversely, the patient with marked basilar artery dilatation (ectasia) is far more likely to present with multiple compressive or ischemic neurologic deficits. Conventional angiography in patients with dilated basilar arteries carries a significant risk for brainstem ischemia. Most authors agree that when vertebrobasilar dolichoectasia has been demonstrated by computed tomography, additional angiography, if required at all, should be performed by digital subtraction techniques.
为了更好地明确椎基底动脉迂曲扩张的临床意义，我们对两组有症状的患者的临床体征和症状以及基底动脉的直径、高度和横向位置参数进行了评估。10例患者仅累及第三、第六或第七颅神经。另外10例患者有多种神经功能缺损，包括压迫性颅神经缺损、缺血性和压迫性中枢神经系统缺损以及脑积水的组合。虽然这两组患者的基底动脉平均直径和高度存在显著差异，但症状和基底动脉参数呈现出一个连续谱。有症状但基底动脉管径正常却迂曲的患者更可能仅累及颅神经。相反，基底动脉明显扩张（迂曲扩张）的患者更可能出现多种压迫性或缺血性神经功能缺损。基底动脉扩张患者进行传统血管造影有导致脑干缺血的重大风险。大多数作者一致认为，当计算机断层扫描已证实存在椎基底动脉迂曲扩张时，若确实需要进一步血管造影，应采用数字减影技术进行。
