椎骨動脈解離性動脈瘤に対する血管内治療による母血管閉塞術 : 穿通枝閉塞による Wallenberg 症候群を防ぐために

Abstract

In this paper, we retrospectively analyze the factors related to infarction of the medulla oblongata causing Wallenberg syndrome after endovascular trapping for dissecting aneurysm of the vertebral artery (VA). Seven cases of dissecting aneurysm of the VA including 5 ruptured cases were treated with endovascular coil embolization between 2003 and 2009 in our hospital. The posterior inferior cerebellar arteries (PICA) originated proximal to the aneurysm in 1 case, at the site of the aneurysm in 1 case, distal in 2 cases, and from the basilar artery (BA) in 3 cases. Complete obliteration of the dissecting aneurysms preserving blood flow of the PICA and opposite VA could be obtained in all cases except 1 case in which the aneurysm involved the PICA. No rebleeding was experienced, but infarction of the lateral medulla occurred in all 3 cases in which the PICA originated from the BA. Though the outcome of the 3 cases was favorable (mRS 0-2; 100%), surgeons should be aware of the risk of the trapping of the VA if the PICA originate from the BA.