後下小脳動脈を含まない椎骨動脈紡錘状動脈瘤の脳血管内治療成績

抄録

Background: Trapping or neck bridge stent placement technique to preserve the parent artery has been performed as a treatment strategy for fusiform vertebral aneurysm. However, there is a concern that brain stem infarction will occur due to occlusion of the vertebral perforators. In this study, the treatment course of 17 cases in 3 years was retrospectively reviewed.

Material and Method: Seventeen cases of fusiform vertebral aneurysm managed by an operator from 2015 were recorded, of which seven were ruptured and nine were unruptured aneurysms and one aneurysm was retreated after the first session because of recanalization. In ruptured cases, the entire aneurysm was treated with trapping. While in seven cases of unruptured aneurysm, stents were placed to preserve the parent artery, and coil embolization was performed.

Result: In six ruptured cases (75%), in which trapping was performed, a high-signal lesion was detected by postoperative magnetic resonance imaging and diffusion-weighted imaging (DWI) of the brain stem (42.9%). However, in seven cases where stents (1 Enterprise VRD, 4 Lvis Jr, 2 NeuroformAtlas) were used, a high signal lesion was detected by DWI in one patient (14.3%) postoperatively, and no new neurological symptoms were observed. In all cases, postoperative bleeding was not observed. Previously, no regrowth of the aneurysm was observed, but in one patient, recanalization was performed in the acute phase after 3 weeks of treatment, and additional treatment was performed.

Conclusion: As a treatment strategy for vertebral aneurysm of nonposterior inferior cerebellar artery involved type, presently, trapping in ruptured cases and stent-assisted coil treatment in unruptured cases are acceptable. Compared with open surgery, intravascular treatment without direct manipulation of the lower cranial nerve allows treatment with few complications. New imaging technologies, such as cone-beam computed tomography, seemed to be useful.