颅颈交界区复杂椎动脉变异伴V3段开窗及颈外动脉来源侧支重建

文献信息

中文摘要

背景： 椎动脉（VA）通过复杂的胚胎学过程发育，成人中可能遇到各种解剖变异。椎动脉开窗（VAF）是一种罕见的先天性血管异常，在影像学上可能模仿椎动脉夹层，需要根据血管形态和影像学表现仔细鉴别。椎动脉起始部未显影、开窗以及颈外动脉来源侧支循环共存的情况并不常见。
病例介绍： 一名45岁男性，无脑血管疾病史或传统血管危险因素，在常规健康体检中接受了磁共振血管成像（MRA）。MRA显示多处脑血管异常，包括双侧椎动脉狭窄、终末基底动脉开窗、持续性胎儿型右侧大脑后动脉、双侧大脑后动脉远端狭窄、双侧大脑前动脉A1/A2交界处狭窄以及脑动脉粥样硬化改变。患者无症状，无头痛、头晕、恶心、呕吐、复视、旋转性眩晕、饮水呛咳、吞咽困难或肠道膀胱功能障碍等神经系统表现。随后进行了全脑数字减影血管造影（DSA）以进一步明确血管解剖。数字减影血管造影显示右侧椎动脉起始部未显影，提示近端闭塞。选择性右侧颈外动脉造影显示侧支血管起源于颈深动脉分支、肋颈干和枕动脉。这些血管通过肌肉吻合为右侧椎动脉V3段提供侧支供血，导致远端椎动脉重建和后循环显影。
结论： 本病例展示了一种罕见的复杂椎动脉解剖变异模式。DSA不仅确定了椎动脉闭塞的位置，还显示了异常侧支循环的来源和血管重建模式，为复杂椎动脉变异提供了重要的诊断信息。

英文摘要

BACKGROUND: The vertebral artery (VA) develops through a complex embryological process, and various anatomic variations may be encountered in adults. Vertebral artery fenestration (VAF) is a rare congenital vascular anomaly that may mimic vertebral artery dissection on imaging and requires careful differentiation based on vascular morphology and imaging findings. The coexistence of vertebral artery origin nonopacification, fenestration, and external carotid artery-derived collateral circulation is uncommon.
CASE PRESENTATION: A 45-year-old man with no history of cerebrovascular disease or conventional vascular risk factors underwent magnetic resonance angiography (MRA) during a routine health examination. MRA revealed multiple cerebrovascular abnormalities, including bilateral vertebral artery stenosis, terminal basilar artery fenestration, persistent fetal-type right posterior cerebral artery, distal stenosis of the bilateral posterior cerebral arteries, stenosis at the bilateral anterior cerebral artery A1/A2 junctions, and cerebral atherosclerotic changes. The patient was asymptomatic, without neurological manifestations such as headache, dizziness, nausea, vomiting, diplopia, rotational vertigo, choking during drinking, dysphagia, or bowel and bladder dysfunction. Whole-brain digital subtraction angiography (DSA) was subsequently performed to further characterize the vascular anatomy.Digital subtraction angiography demonstrated nonopacification of the origin of the right vertebral artery, suggesting proximal occlusion. Selective right external carotid artery angiography revealed collateral vessels originating from branches of the deep cervical artery, costocervical trunk, and occipital artery. These vessels provided collateral supply to the V3 segment of the right vertebral artery through muscular anastomoses, resulting in reconstitution of the distal vertebral artery and visualization of the posterior circulation.
CONCLUSION: This case demonstrates a rare pattern of complex vertebral artery anatomic variation. DSA not only identified the location of vertebral artery occlusion but also demonstrated the origin of abnormal collateral circulation and the pattern of vascular reconstruction, providing important diagnostic information for complex vertebral artery variations.