Anatomy of segmental duplication in the human basilar artery. Possible site of aneurysm formation.

Segmental duplications of the basilar artery, previously reported exclusively as anatomical variations, owe their clinical interest to the possible association with aneurysms localized at the junctions of the fenestrated segments. The morphological characteristics of 5 cases of basilar artery segmental duplication without aneurysms, found at autopsy, are reported. In 3 of these the proximal junction of the fenestrated segment was studied with scanning electron microscopy and morphometry. In all cases the tunica media of the medial wall of the 2 branches showed a progressive thinning towards the junctions of the fenestrated segments and a small muscular gap at their apex. The limited medial defect might be embryologically ascribed to the persistence of the morphological individuality of the tunica media of the 2 branches at the point where the fusion of the primitive longitudinal neural arteries stopped. The review of the literature shows that the morphology of the junctions of the fenestrated segments is in conformity with that of the intracranial arterial bifurcations. For this reason the basilar artery fenestration exposes to the blood flow a new distal bifurcation where the same etiologic factors that are still under discussion in the origin of saccular intracranial aneurysms may be active.