椎动脉远端发育异常伴基底动脉开窗畸形合并相关动脉瘤1例  

One case of distal vertebral artery dysplasia associated with basilar artery fenestration malformation and related aneurysm

作　　者：刘建武 何婷 况莹 朱健明[1] 陈志华[1] LIU Jian-wu;HE Ting;KUANG Ying;ZHU Jian-ming;CHEN Zhi-hua(Department of Neurosurgery,Second Affiliated Hospital,Nanchang University,Nanchang 330006,China;Department of Neurosurgery,Ganzhou People's Hospital,Ganzhou 341000,China)

机构地区：[1]南昌大学第二附属医院神经外科,南昌330000 [2]赣州市人民医院神经外科,江西341000

出　　处：《中国临床神经外科杂志》2024年第10期633-634,637,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：椎动脉远端发育异常临床不少见,但伴基底动脉开窗畸形的病人并不多见,合并相关动脉瘤更是罕见。本文报道1例椎动脉远端发育异常伴基底动脉开窗畸形合并相关动脉瘤,为50岁女性,因突发头痛14 h入院;入院Hunt-Hess评分Ⅱ级;急诊颅脑CTA显示蛛网膜下腔出血,基底动脉开窗畸形;右侧椎动脉造影见基底动脉开窗畸形合并动脉瘤,动脉瘤大小约2.6 mm×2.7 mm,瘤颈约2.8 mm。行支架辅助下颅内动脉瘤栓塞术,术后即刻造影显示动脉瘤完全栓塞,载瘤血管通畅,开窗通道显影良好;术后12个月复查DSA未见动脉瘤复发,原有开窗通道未显影;无新发脑出血、脑梗塞,无神经功能缺损。临床上,椎动脉远端发育异常伴基底动脉开窗畸形合并相关动脉瘤临床罕见,诊断推荐DSA,建议采用血管内治疗,应注意保护分支血管、尽量保护开窗环;使用支架辅助栓塞治疗可能增加缺血事件风险,应注意预防。Distal developmental abnormalities of the vertebral artery are not uncommon in clinic;however,theses patients with basilar artery fenestration malformations are rare,and those with associated aneurysms are even rarer.This article reports a case of a 50-year-old female who was admitted to hospital due to sudden headache for 14 hours;the Hunt-Hess score upon admission was gradeⅡ;emergency cranial CTA revealed subarachnoid hemorrhage and basilar artery fenestration malformation;right vertebral artery angiography showed basilar artery fenestration malformation with an aneurysm,approximately 2.6 mm×2.7 mm in size,and the aneurysm neck was about 2.8 mm.Stent-assisted embolization of the intracranial aneurysm was performed.Immediate angiography after the operation showed complete embolization of the aneurysm,patency of the parent artery,and good visualization of the fenestration channel;at the 12-month follow-up DSA,no recurrence of the aneurysm was observed,and the original fenestration channel was not visualized;there was no new cerebral hemorrhage,cerebral infarction,or neurological deficits.Clinically,the combination of distal developmental abnormalities of the vertebral artery,basilar artery fenestration malformation,and associated aneurysms is extremely rare.DSA is recommended for diagnosis,and endovascular treatment is suggested.Attention should be paid to protecting branch vessels and the fenestration ring as much as possible;the use of stent-assisted embolization may increase the risk of ischemic events,and precautions should be taken.

关 键 词：椎动脉远端发育异常 基底动脉开窗畸形 颅内动脉瘤 血管内治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]