title: Vertebrobasilar junction fenestration associated with dissecting aneurysm of intracranial vertebral artery.
abstract: BACKGROUND
  Vertebrobasilar junction fenestration is considered to be a subtype of fenestration of the proximal basilar artery, which has been described only in autopsy cases. The fenestration associated with a dissecting vertebral aneurysm is extremely rare.
  
  
  METHODS
  A 47-year-old man presented with subarachnoid hemorrhage. The four-vessel angiogram showed a fusiform dilatation with an intimal flap of the left vertebral artery distal to the origin of the posterior inferior cerebellar artery and a fenestration at the vertebrobasilar junction, in which 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 basilar artery. The dissecting aneurysm was treated with body clipping by directly clipping the ruptured portion of the aneurysm via a suboccipital approach in an early operation 48 hours after the ictus. The patient had a good recovery and returned to his work. He is well at a 5-year follow-up.
  
  
  CONCLUSIONS
  The relevant angiographic features of the vertebrobasilar junction fenestration and the surgical treatment of such associated aneurysms are discussed.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Q J
authors.initials: QJ
authors.lastname: Zhang
authors.forename: S
authors.initials: S
authors.lastname: Kobayashi
authors.forename: H
authors.initials: H
authors.lastname: Gibo
authors.forename: K
authors.initials: K
authors.lastname: Hongo
mesh_terms: D000784:Aortic Dissection / Q000150:complications* / Q000473:pathology; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000473:pathology; D001488:Basilar Artery / Q000002:abnormalities*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000473:pathology; D014711:Vertebral Artery / Q000002:abnormalities* / Q000473:pathology*