椎骨脳底動脈合流部の窓形成に伴う動脈瘤―GDCコイル塞栓術の1例

An Aneurysm Located at a Fenestration of the Vertebrobasilar Junction Successfully Treated with Guglielmi Detachable Coils

Ⅰ．はじめに

　われわれは，椎骨脳底動脈合流部の窓形成に伴う動脈瘤という稀な疾患に対してGDCコイル塞栓術を行い，2つの術中合併症にもかかわらず良好な結果を得たので報告する．

　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.