VERTEBROBASILAR JUNCTION FENESTRATION ASSOCIATED WITH DISSECTING ANEURYSM OF INTRACRANIAL VERTEBRAL ARTERY

Background Vertebrobasilar junction fenestration is considered to be a subtype of fenestration of the proximal basilar artery, which has bee n described only in autopsy cases. The fenestration associated with a dissecting vertebral aneurysm is extremely rare. Case Description A 47 -year-old man presented with subarachnoid hemorrhage. The four-vessel angiogram showed a fusiform dilatation with an intimal flap of the lef t vertebral artery distal to the origin of the posterior inferior cere bellar artery and a fenestration at the vertebrobasilar junction, in w hich a small limb of the fenestration arising from the distal portion of the left vertebral artery bridged the proximal basilar trunk, while another limb had a large diameter showing the same diameter as the ba silar artery. The dissecting aneurysm was treated with body clipping b y directly clipping the ruptured portion of the aneurysm via a subocci pital approach in an early operation 48 hours after the ictus. The pat ient had a good recovery and returned to his work. He is well at a 5-y ear follow-up. Conclusions The relevant angiographic features of the v ertebrobasilar junction fenestration and the surgical treatment of suc h associated aneurysms are discussed.