Vertebral-Basilar Junction Aneurysms: 77 Patients
Because intracranial saccular aneurysms ordinarily arise at the carina of a bifurcation on which the higher velocity, axial arterial stream impinges, it would seem incongruous for aneurysms to arise in the region of the union of the vertebral arteries that forms the basilar artery. What has been realized is that in most cases they do not arise at that carina projecting downward, but rather arise at the lower carina of a fenestration at the origin of the basilar artery, pointing upward. The occurrence of aneurysms at proximal carinae of fenestrations here at the basilar origin, on the mid-basilar, and on other arteries is compelling additional evidence for the hemodynamic factor in the origin of intracranial aneurysms. Even where a fenestration was not evident in the angiogram, small or even incomplete clefts have been recognized at operation. Fenestration was verified in X-rays or at operation in 32 cases, with increasing frequency in the last half of the time period. In five where one vertebral artery ended in PICA, the aneurysm seemed to arise on the side of the basilar artery where the vertebral union would have been.
KeywordsVertebral Artery Basilar Artery Sigmoid Sinus Lateral Sinus Suboccipital Craniectomy
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