13. 血管撮影上紡錘形を呈する椎骨動脈瘤の治療

-proximal clip occlusion およびcoatingの効果-

抄録

Among 181 cases of 189 posterior circulation aneurysms, there were 65 with 69 vertebral aneurysms and 20 with 21 fusiform aneurysms. Dissecting aneurysms and true fusiform aneurysms were included in this series.
1) Angiographical differentiation between the two above pathological processes is very difficult in some cases. Most dissecting aneurysms have a dilated portion and a narrowing of various degrees (“pearl and string sign”).
2) In a long-term follow-up study, a proximal clip occlusion of the vertebral artery and Biobond coating were effective in preventing recurrent hemorrhage. There were no postoperative deaths and no rebleeding, but two cases of ischemic stroke lateral medullary syndrome-were found. Both were treated by a proximal clip occlusion distal to the posterior inferior cerebellar artery. The patency of the distal vertebral artery and its perforators were important. Probably a long distal cul-de-sac vertebral artery is more risky than a shorter one.