Journal of Korean Neurosurgical Society

  • 제39권5호
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  • Pages.355-359
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  • 2006
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지

Fenestration and Duplication of the Vertebrobasilar Artery Detected by Conventional Angiography and Magnetic Resonance Angiography

  • Ahn, Jae-Heung (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Kim, Myoung-Soo (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Lee, Hyun-Koo (Department of Neurosurgery, Cheongju Saint Mary's Hospital) ;
  • Lee, Seung-Jun (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Park, Hyo-Il (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Lee, Chae-Heuck (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine)
  • 발행 : 2006.05.30
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초록

Objective : The purpose of our study is to examine the clinical significance of vertebrobasilar artery[VBA] fenestration and duplication. In addition, we review its incidence and pathogenesis. Methods : Cerebral angiography was performed in 803 patients and magnetic resonance angiography[MRA] in 880; the patients had or were suspected to have cerebrovascular disease. We retrospectively reviewed angiography and MRA. Results : Fifteen patients [eight men, seven women, 3 to 77 years of age, median age = 58 years] had a VBA fenestration and duplication. Seven [7/803 = 0.87%] of the patients undergoing cerebral angiography revealed fenestrations and one duplication of VBA. Ten patients [10/880 = 114%] among 880 patients that underwent MRA demonstrated fenestration of basilar artery[BA]. Two of 66 patients that underwent both conventional cerebral angiography and cranial MRA showed a fenestration of BA. Twelve fenestrations were located in the proximal portion of the BA and one was in the mid portion of the BA. One vertebral artery[VA] fenestration was located in the intracranial portion of the right VA, and one VA duplication was at the level of $C_{1-2}$ in the left VA. Conclusion : In addition to medial defects, flow phenomena at the proximal end of fenestrations, where hemodynamic stress and increased turbulence are present, may contribute to aneurysm formation. And arterial fenestration is a predisposing factor in vascular injury and cerebral ischemia.

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참고문헌

  1. Ahn JY, Kwon SO : Arteriovenous malformation at cerebellopontine angle associated with a fenestration of the vertebral artery. Korean J Cerebrovasc Dis 2 : 200-204, 2000
  2. Andrews BT, Brant-Zawadzki M, Wilson CB : Variant aneurysms of the fenestrated basilar artery. Neurosurgery 18 : 204-207, 1986 https://doi.org/10.1227/00006123-198602000-00017
  3. Antunes JL, Valenca A, Ferro JM, Campos J : Ruptured saccular aneurysm associated with duplication of the vertebral artery. Surg Neurol 36 : 207-209, 1991 https://doi.org/10.1016/0090-3019(91)90114-O
  4. Berry AD 3rd, Kepes JJ, Wetzel MD : Segmental duplication of the basilar artery with thrombosis. Stroke 19 : 256-260, 1988 https://doi.org/10.1161/01.STR.19.2.256
  5. Black SP, Ansbacher LE : Saccular aneurysm associated with segmental duplication of the basilar artery. An morphological study. J Neurosurg 61 : 1005-1008, 1984 https://doi.org/10.3171/jns.1984.61.6.1005
  6. Campos J, Fox AJ, Vinuela F, Lylyk P, Ferguson GG, Drake CG : Sacculr aneurysms in basilar artery fenestration. Am J Neuroradiol 8 : 233-236, 1987
  7. De Caro R, Parenti A, Munari PF : Fenestration of the vertebrobasilar junction. Acta Neurochir (Wien) 108 : 85-87, 1991 https://doi.org/10.1007/BF01407673
  8. Finlay HM, Canham PB : The layered fabric of cerebral artery fenestrations. Stroke 25 : 1799-1806, 1994 https://doi.org/10.1161/01.STR.25.9.1799
  9. Giuftre R, Sherkr S : The vertebral artery : developmental pathology. J Neurosurg Sci 43 : 175-189, 1999
  10. Graves VB, Strother CM, Weir B, Duff TA : Vertebrobasilar junction aneurysms associated with fenestration : treatment with Guglielmi detachable coils. Am J Neuroradiol 17 : 35-40, 1996
  11. Hasegawa T, Hubota T, Ito H, Yamamoto S : Symptomatic duplication of the vertebral artery. Surg Neurol 20 : 244-248, 1983 https://doi.org/10.1016/0090-3019(83)90061-7
  12. Hong DY, Kim MC, Lee SP, Choi GH, Yeo HT : Fenestrate anomaly of a vertebral artery with repeated attack of ischemic stroke. J Korean Neurosurg Soc 31 : 71-73, 2002
  13. Kalia KK, Pollack IF, Yonas H : A partially thrombosed, fenestrated basilar artery mimicking an aneurysm of the vertebrobasilar junction : case report. Neurosurgery 30 : 276-278, 1992 https://doi.org/10.1227/00006123-199202000-00025
  14. Kim K, Mizunari T, Kobayashi S, Ishii S, Teramoto A : Occipital neuralgia caused by the compression of the fenestrated vertebral artery : a case report. No Shinkei Geka 27 : 645-650, 1999
  15. Komiyama M, Nakajima H, Nishikawa M, Yasui T, Kan M : Treatment of a saccular aneurysm at the fenestration of the intracranial vertebral artery with guglielmi detachable coils. Acta Neurochir (Wien) 141 : 1125-1127, 1999 https://doi.org/10.1007/s007010050495
  16. Kowada M, Yamaguchi K, Takahashi H : Fenestration of the vertebral artery with a review of 23 cases in Japan. Radiology 103 : 343-346, 1972 https://doi.org/10.1148/103.2.343
  17. Koyanagi S, Shiraishi T, Ueta K, Tabuchi K : Bilateral fenestration of the vertebrobasilar artery with Huglielmi detachable coils. Acta Neurochir (Wien) 31 : 995-998, 1991
  18. Kubo M, Hacein-Bey L, Varelas PN, Ulmer JL, Lemke DM, Cusick JF : Ruptured saccular aneurysm of distal vertebral artery fenestration managed with Guglielmi detachable coils and intraventricular tissue plasminogen activator. Surg Neurol 63 : 244-248, 2005 https://doi.org/10.1016/j.surneu.2004.02.038
  19. Kyung DH, Kang HI, Moon BG, Lee SJ, Kim JS, Yoo IK : A case of fenestrated basilar artery associated with multiple aneurysms. J Korean Neurosurg Soc 28 : 1529-1533, 1999
  20. Mizukami M, Tomita T, Mine T, Mihara H : Bypass anomaly of the vertebral artery associated with cerebral aneurysm and arteriovenous malformation. J Neurosurg 37 : 204-209, 1972 https://doi.org/10.3171/jns.1972.37.2.0204
  21. Morikawa K, Ohkawa N, Yamashita S : Surgical decompression for the C-1 and C-2 sensory roots and upper cervical cord in a case with cervical myelopathy and occipital neuralgia due to bilateral fenestration of vertebral artery : a case report. No Shinkei Geka 21 : 1035-1038, 1993
  22. Padget DH : The development of the cranial arteries in the human embryo. Contrib Embryol 32 : 205-261, 1948
  23. Rogers LA : Acute subdural hematoma and death following lateral cervical spinal puncture. Case report. J Neurosurg 58 : 284-286, 1983 https://doi.org/10.3171/jns.1983.58.2.0284
  24. Sanders WP, Sorek PA, Mehta BA : Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. Am J Neuroradiol 14 : 675-680, 1993
  25. Schmidt H, Pfingst E : Duplication of the vertebral artery. Fortschr Geb Rontgenstr Nuklearmed 118 : 636-640, 1973 https://doi.org/10.1055/s-0029-1229619
  26. Shishido T, Watanabe M, Kuramoto S : A case of giant aneurysm associated with vertebral fenestration. No Shinkei Geka 7 : 79-83, 1979
  27. Steven L, Melanie B, Oscar M : What is a 'normal anatomic variant'? Transient left lateral medullary ischemia in a patient with a fenestrated left vertebral artery. Neurology 44 : 1358-1359, 1994 https://doi.org/10.1212/WNL.44.7.1358
  28. Takahashi M, Tamakawa Y, Kishikawa T, Kowada M : Fenestration of the basilar artery. Report of three cases and review of the literature. Radiology 109 : 79-82, 1973
  29. Tasker AD, Byrne JV : Basilar artery fenestration in association with aneurysms of the posterior cerebral circulation. Neuroradiology 39 : 185-189, 1997 https://doi.org/10.1007/s002340050389
  30. Teal JS, Rumbaugh CL, Bergeron RT, Segall HD : Angiographic demonstration of fenestrations of the intradural intracranial arteries. Radiology 106 : 123-126, 1973 https://doi.org/10.1148/106.1.123
  31. Uchino A, Kato A, Takase Y, Kudo S : Basilar artery fenenstrations detected by MR angiography. Radiat med 19 : 71-74, 2001
  32. Uchiyama S, Yoshinaga T, Shima T : A case of basilar artery fenestration with recurrent attacks of vertebrobasilar insufficiency. No To Shinkei 39 : 1163-1169, 1987
  33. Wollschlaeger G, Wollschlaeger PB, Lucas FV, Lopez VF : Experience and result with postmortem cerebral angiography performed as routine procedure of the autopsy. Am J Roentgenol Radium Ther Nucl Med 101 : 68-87, 1967 https://doi.org/10.2214/ajr.101.1.68
  34. Yoon SM, Chun YI, Kwon Y, Kwun BD : Vertebrobasilar junction aneurysms associated with fenestration : experience of five cases treated with Guglielmi detachable coils. Surg Neurol 61 : 248-254, 2004 https://doi.org/10.1016/S0090-3019(03)00485-3