Fenestrated Basilar Artery Aneurysmの1手術例

Fenestrated Basilar Artery Aneurysm : case report

I．はじめに

　椎骨脳底動脈領域の血管異常については，遺残動脈，重複，窓形成などが知られているが，これらの血管異常と，脳動脈瘤，脳動静脈奇形との合併の報告も散見される^1-5,8-14）．今回われわれは，椎骨脳底動脈窓形成部に，脳動脈瘤を合併した稀な症例を経験し，直達手術にて良好な結果が得られたので，文献的考察を加え報告する．

The authors reported an operated case with an aneurysm arising from the proximal end of basilar arteryfenestration, and discussed its etiology and surgical strategy. A 47-year-old woman presented with slightmemory disturbance. Neuroradiologic examination revealed an aneurysm located on the proximal end ofthe basilar artery 12×9mm in size at the level of the outer auditory meatus. The union of vertebral arterieshad deviated toward the right side, and the aneurysmal dome had projected into the fenestration. Throughthe right far lateral approach, we applied two straight fenestrated clips X configuration to the aneurysm.

Several authors have reported a variety of approaches for vertebrobasilar aneurysms along the midlinewith consideration of the height of the aneurysmal. However, another point of view is that attentionshould be paid to the direction of the clip blade and applied at the final clipping, because, for vertebrobasi-lar aneurysms adjacent to the midline, the surgical view and working space are extremely restricted.