Zhang Q J, Kobayashi S, Gibo H, Hongo K
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Stroke. 1994 Jun;25(6):1273-5. doi: 10.1161/01.str.25.6.1273.
Vertebrobasilar junction fenestration is considered to be a subtype of fenestration of the proximal basilar artery, which has been described only in autopsy cases. The fenestration associated with a dissecting vertebral aneurysm is extremely rare.
A 47-year-old man presented with subarachnoid hemorrhage. The four-vessel angiogram showed a fusiform dilatation with an intimal flap of the left vertebral artery distal to the origin of the posterior inferior cerebellar artery and a fenestration at the vertebrobasilar junction, in which a small limb of the fenestration arising from the distal portion of the left vertebral artery bridged the proximal basilar trunk, while another limb had a large diameter showing the same diameter as the basilar artery. The dissecting aneurysm was treated with body clipping by directly clipping the ruptured portion of the aneurysm via a suboccipital approach in an early operation 48 hours after the ictus. The patient had a good recovery and returned to his work. He is well at a 5-year follow-up.
The relevant angiographic features of the vertebrobasilar junction fenestration and the surgical treatment of such associated aneurysms are discussed.
椎基底动脉交界处开窗被认为是基底动脉近端开窗的一种亚型，此前仅在尸检病例中有过描述。与椎动脉夹层动脉瘤相关的开窗极为罕见。
一名47岁男性出现蛛网膜下腔出血。四血管造影显示，在小脑后下动脉起源远端的左椎动脉呈梭形扩张并伴有内膜瓣，且在椎基底动脉交界处有开窗，其中开窗的一个小分支起自左椎动脉远端，连接基底动脉近端主干，而另一个分支直径较大，与基底动脉直径相同。在发病48小时后的早期手术中，通过枕下入路直接夹闭动脉瘤破裂部分，对夹层动脉瘤进行了瘤体夹闭治疗。患者恢复良好并重返工作岗位。在5年的随访中，他情况良好。
讨论了椎基底动脉交界处开窗的相关血管造影特征以及此类相关动脉瘤的手术治疗方法。
