窓形成を伴った椎骨動脈合流部のlarge動脈瘤の治療例

Abstract

We highlighted 2 cases of radical clipping of large aneurysms that were seen in the vertebrobasilar junction accompanied by a vascular deformity, consisting of fenestration of the split basilar artery at the origin of the basilar artery. Information concerning the inner and outer surface of the aneurysm were obtained pre-operatively from neuroradiographic studies by 3-D CT and 3-D CT endoscopy of the position of the neck, parent vessels of the vertebral arteries on both side, basilar artery and split basilar artery as well as its branches. The neck had a broad base in both cases. The height of the neck extended to the internal acoustic meatus, and it was possible to expose the periphery of the aneurysmal neck with an anterior transpetrosal approach. Based on the size of the aneurysm which was placed on the anterior surface of the brain stem, clipping or arterial reconstruction were performed in the first case under cover of barbiturates and deep hypothermia extracorporeal circulation, and in the second case in a state of circulatory arrest. The following provides a report of these 2 cases along with other cases treated so far.