脳底動脈窓形成部動脈瘤に対する血管内治療の有用性

Endovascular Treatment of Basilar Artery Aneurysms Associated with Fenestration

Ⅰ．はじめに

　椎骨脳底動脈（VA-BA）合流部の動脈瘤は稀であり，しばしば脳底動脈の窓形成（fenestration）と関連することが知られている^{1,3,5,8,24,28,36,42)}．同部の解剖の複雑性や開頭手術の困難性^5,7)から血管内治療の有用性が指摘されている^{6,17,22,24,28,38,42)}．今回，われわれが経験した脳底動脈窓形成部動脈瘤の連続10症例について，文献的考察を含めて報告する．

　Aneurysms at the vertebrobasilar junction are often found with basilar artery（BA）fenestration. We encountered 10 consecutive cases of aneurysms associated with BA fenestration. The purpose of this study is to describe the frequency, clinical features, and outcome of these aneurysms treated by endovascular procedure.

　The incidence of these aneurysms in our series was 1.9%. All aneurysms were successfully treated by coil embolization. Half of them were treated by using simple technique, and the other half were treated by using adjunctive techniques such as balloon remodeling technique. 70% of these cases were ruptured, and all except one case showed good recovery at the time of discharge.

　We found 63 reported cases of this aneurysm in the literature between 2000 and 2012. 57 out of 63 aneurysms were treated by endovascular means with good clinical results. The usefulness of endovascular procedure is reported to be superior to surgical clipping because of their anatomical complexity and the difficulty of surgical exposure for clipping.

　We conclude that outcome of these aneurysms is favorable and endovascular procedure has become their standard treatment for these aneurysms.