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[Angiography for intracranial aneurysms of the vertebrobasilar system (author's transl)]
Insights
This study highlights the prevalence and locations of vertebro-basilar system aneurysms. Selective vertebral angiography is crucial for diagnosing these intracranial aneurysms, with specific projections enhancing visualization.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Intracranial aneurysms pose significant health risks.
- The vertebro-basilar system is a critical vascular network in the brain.
Purpose of the Study:
- To analyze the incidence and precise locations of aneurysms within the vertebro-basilar system.
- To evaluate and recommend optimal imaging techniques for diagnosing these specific aneurysms.
Main Methods:
- Retrospective analysis of 112 patients with 122 intracranial aneurysms.
- Detailed review of diagnostic angiography, focusing on selective vertebral angiography.
- Utilized special projections (transoral, transfacial) and techniques like angiotomography and subtraction.
Main Results:
- Eleven percent (9%) of intracranial aneurysms were located in the vertebro-basilar system.
- Common sites included the inferior posterior cerebellar artery origin and basilar artery bifurcation.
- Rare peripheral cerebellar vessel and basilar artery stem aneurysms were also identified.
Conclusions:
- Selective vertebral angiography, particularly with high catheter positioning, is essential for diagnosing vertebro-basilar aneurysms.
- Bilateral vertebral angiography and specialized projections/techniques improve diagnostic accuracy.
- Accurate diagnosis is critical for appropriate management of these vascular lesions.
Abstract:
Amongst 112 patients with a total of 122 intracranial aneurysms, there were eleven (9%) in the vertebro-basilar system. Four of the vertebral artery aneurysms were situated at the origin of the inferior posterior cerebellar artery, three at the bifurcation of the basilar artery; there were three rare aneurysms situated peripherally on the cerebellar vessels and there was one circumscribed aneurysm of the basilar artery stem. Selective vertebral angiography, with high position of the catheter, is recommended for the demonstration of these aneurysms. If there is insufficient reflux into the opposite vertebral artery from a left-sided injection, bilateral vertebral angiography must be carried out. Special projections, such as transoral (open-mouth) or transfacial may be of advantage. Angiotomography has also proved valuable and magnification can be helpful. Subtraction is particularly indicated for sagittal projections.