HANDA, JYOJI

KIDOOKA, MINORU

NAKASU, SATOSHI

NAKASU, YOKO

Kyoto University Research Information Repository

TitleAneurysm at the Fenestration of Basilar Artery : Case ReportAuthor(s)NAKASU, YOKO; NAKASU, SATOSHI; KIDOOKA,MINORU; HANDA, JYOJICitation日本外科宝函 (1982), 51(2): 344-348Issue Date1982-03-01URL http://hdl.handle.net/2433/208928RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityArch Jpn Chir 51(2), 344～348, Marz, 1982 症例Aneurysm at the Fenestration of Basilar Artery -Case Report YoKo l¥AKASu, SATOSHI NAKASu, MrnoRu KrnooKA, Jvo11 RANDA Department of Neurosurgery, Shiga I’niversity of i¥!edical Science (Director: Prof. Dr. ]YO.JI HANDA) Received for Publication, Jun. 1. 1982. An aneurysm arising at the fenestration of the cerebral artery is rare. Recently we encount-ered a patient with an aneurysm at the fenestration of the basilar artery. Report of a case One morning, this 49 year old man noted a weakness in his right leg, which progressed to a right hemiparesis including the face. Computed tomographic (CT) scan on admission to a local hospital was reportedly normal. His hemiparesis improved gradually in 3 months. However、a repeated CT scan with a contrast administration disclosed a large‘enhancing lesion in the posterior cranial fossa (Fig. 1). The patient was referred to us for further examinations . .'¥eurologic examinations on admission were normal except for a mild residual weakness involving the right upper extremity. Laboratory examinations showed high serum triglyceride levels and low serum HDL-cholesterol levels. A vertebral angiography by a femoral route showed a large aneurysm of the left vertebral artery (Fig. 2). In addition, there was found a fenestration of the middle third of the basilar artery, and a small aneurysm at the proximal end of the fenestration. Bilateral carotid angiographies were noncontributory. No parenchymatous lesions were found by a repeated CT scanning. He was discharged without an operation. At a follow-up visit 8 months later‘he is neurologically normal except for a minimal weakness of his right arm. Discussion Accorcing to P ADGETt3＞‘ the basilar artery is formed by a fusion of the paired primitive longitudimal neural arteries during the second to fourth stage of embryonic development. An incomplete fusion for unknown reasons results in a fenestration, or a partial duplication‘of the basilar artery. Although the fenestration of the basilar artery has been de日「ribedboth in anatom-Key words: Basilar artery, Cerebral aneurysm, Cerebral arteries, Fenestration. 索引語：脳底動脈，脳動脈癒，脳動脈，窓形成．Present address: Jyoji IIanda, ¥l.D., Department of Neurosurgery‘Shiga University of 1¥1 edical Science, Seta, Ohtsu, Shiga, 520-21, Japan. A NEU RY日l¥lAT BASILAR ARTERY FE'.'¥ESTRλTIO:¥ Fig. 1. CT scan showing enhanced mass in the left cerelぽllopontineangle (vertebral artery aneurysm). 345 ical specimenメandin angiographic literature1,.,14,15.i"1sJ、itis generally thought to be an in-frequent vascular anomaly. TAKAHASHI et al.14＞白timatedits angiographic incidence to be approximately 0.6 per cent. However, an angiographic identification of this anomaly tends to be hampered by superimposition of the mastoid cells or of dense bones of the skull base, and the low incidence in the previous reports may well be related to oversight. The fenestration of the cerebral artery usually belongs to an incidental finding. But a simultaneous occurrence of other cerebrovascular anomalies has also been reported、particularlyin the cases with the fenestration of the anterior cerebral, middle cerebral or vertebral arteries2,5,9,11.r2> In such cases reported previouslyヘhowev何ぅ theaneurysm or artenovenous malformation arose at a different site from the fenestration, and an association of a congenital aneurysm at the site of the fenestration of the basilar artery is very rare. To our knowledge, TA＼’ERAS and ¥VoonI5J were the first to have shown a case with an ane-urysm at the proximal end of the fenestration of the basilar artery. ト.；inccthat time. only few more cases have been reporteda,6,,,IoJー Pertinentdata of a total of 7 cases including the present one are summarized in the Table目 Insix of these 7 cases, the fenestration was found in the proximal portion of the basilar artery, except for our patient in whom the middle third of the basilar trunk was involved. Furthermore, it should be noted here that in al 7 patients the aneurysm arose at the proxim al end of the fenestration. The proximal portion of an arterial fenestration is Y shaped as in the usual arterial branching. It has been nで1established that most congenital aneurysms arise at 346 日外宝第51巻第2号（昭和57年3月）Fig. 2A. Fig. 2B. Fig. 2. Vertebral angiogram showing two aneurysms and the fenestration of the middle third of the basilar artery. Smaller aneurysm arose at the proximal end of the fenestration. (A) posterior anterior view. (B) oblique view. Table Saccular aneurysm at the basilar artery fenestration I i i I Other associated i Location of I Site of I Clinical I I Authors ! Year i A山 x: fenestrat川…州P問 sentatiTaveras & Wood I 1976 r ?/? ! proximal ' proximal i ? I I ! third I end • Hemmati & Kim i 1979 i 35/l¥I 1 proximal i proximal 1 SAH I I i third I end Hoff: an & Wilson Berker & Hamilton l¥l atricali & van Dulken Nakasu et al. 1979 ] 55/F i proximal I proximal , SAH I • third I en 1979 34/M proximal I proximal 1 SAH third I end 1980 47/M proximal I proximal • SAH third i end 38/l¥I proximal i proximal I SAii third I end 1982 49/l¥l middle I pr叩 mal PRIND third I end none neck I clipping i neck clipping I neck clipping neck clipping none none none none none none aneurysm of vertebral artery *: Age in years, SAH subarachnoid hemorrhage, PRIND: prolonged reversible ischemic neurological de五cit.the site of arterial branching where a medial defect is present. CROMPTON4> has described that a similar defect in the media is present in the proximal end of the fenestration of the basilar (as well 出 theanterior cerebral) arteries. It is interesting to note, therefore, that there are remarkable ANEURYSM AT BASILAR ARTERY FENESTRATIO代 347 morphological and hemodynamic similarities between two sites of aneurysmal formation, proximal end of the fenestration and the apex of the arterial branching. References 1) Adachi B: Das Arteriensystem der J apaner. Kyoto/Tokyo: :¥laruzen, 1928, Vol. 1. pp. 119. 2）馬場元毅，清水隆，他：多発脳血管奇形の1例一中大脳動脈窓形成，前交通勤脈痛，および脳動静脈奇形を合併した 1症例について．脳神経外科 5:59 64, 1977. 3) Becker DH, Hamilton RD: Saccular aneurysm associated with fenestrated basilar arteη. Case report. 1¥/ eurosurgery 5: 695-697, 1979. 4) Crompton MR: The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes. Lancet 2: 421 425, 1962. 5) Handa J, Teraura T, et al: A genesis of the corpus callosum associated with multiple developmental anomalies of the cerebral arteries. Radiology 92: 1301-1304, 1969. 6) Hemmati M, Kim KS: A ruptured aneurysm at the basilar artery fenestration. Radiology 130: 174, 1979. 7) HoffmanもNF,Wilson CB: Fenestrated basilar artery with an associated saccular aneurysm. Case report. J Neurosurg 50: 262-264, 1971. 8) Krayenbiihl H, Yasargil MG: Die vaskularen Erkrankungen im Gebiet der Arteria Vertebrali円 undArteria Basialis. Stuttgart: Thieme, 1957, pp. 38 42. 9）郭隆燦，桑原健次，他：中大脳動脈奇形を伴った脳動脈痛一重複中大脳動脈および、中大脳動脈窓形成．脳神経外科 7:691 696, 1979. 10) Matricali B, van Dul ken H: Aneurysm of fenestrated l地引ilarartery. Surg Neurol 15: 189 191, 1981. 11) Miyazaki S, Kamata K, et al: :¥Iultiple aneurysms of the vertebrobasilar system associated with fenestration of the verteLral artery. Surg Neurol 15: 192 195, 1981. 12）水上公宏，峯 徹，他：椎骨動脈窓形成（vertebraldiastematoarteria）ー脳動脈腐，脳動静脈奇形との合併．脳と神経 20:81-86, 1968. 13) Padget DH: The development of the cranial arteries in the human embryo. Contrib Embryol 32: 205-261, 1948. 14) Takahashi M, Tamakawa Y, et al: Fenestration of the basilar artery. Radiology 109: 79 82, 1973. 15) TaveraちJM,Wood EH: Diagnostic Neuroradiology. Ed 2. Baltimore: Williams & Wilkins, 1976, Vol. 2, pp. 795 16) Teal JS, RumLaugh CL, et al: Angiographic demonstration of the intradural intracranial arteries. Radio田logy 106・123-126,1973. 17) von :¥litterwallner F: Variationsstatistische Untersuchungen an den hasalen Hirngefassen. Acta Anat 24 51 87, 1955. 18) ¥Vollschlaeger G, Wollschlaeger PB, et al: 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. 348 日外宝第51巻第2号（昭和57年3月）和文抄録脳底動脈窓形成部に動脈癌を合併した 1症例滋賀医科大学脳神経外科学教室（主任：半田譲二教授）中洲庸子，中洲 敏，木戸岡実，半田譲二脳動脈の窓形成部に動脈痛をみとめることは稀であるが，神経放射線学の進歩によって，最近報告が散見されるようになった．著者らは脳底動脈の窓形成部lζ嚢状動脈癌がみとめられた1症例を経験したので報告し，さらに現在までに報告された6例について合わせて検討を加えた．いづれの場合も動脈癌は窓形成の近位側分岐部lζ発生しており，との部lζ中膜の欠損がみとめられると報告されていることから，動脈痛の成因を考える上で非常に興味深い症例である．

脳底動脈窓形成部に動脈瘤を合併した1症例

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脳底動脈窓形成部に動脈瘤を合併した1症例

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