Abstract
Object: Intracranial VA dissections are reported to cause headache, brain stem infarction, and SAH with an associated high morbidity and mortality. We aimed to clarify both the clinical characteristics and effectual treatment of intracranial VA dissections, and to present a retrospective analysis of our experience in the treatment.
Material and method: Between 1995 and 2007 we experienced 62 VA dissections in our institution. Fourteen of 62 (23%) cases of VA dissections were associated with aneurysm, and received surgical treatment. Five of fourteen cases presented with SAH, 8/14 cases with ischemia, 1/14 cases with headache.
Results: In the hemorrhagic group, internal trapping of aneurysm (ITA) was successfully performed in four cases. In one case, bypass surgery was followed by ITA, while one case with treatment-related complication was observed. But Glasgow Outcome Scale (GOS) of almost all cases was severe; 2/5 cases showed good recovery (GR), and 3/5 cases had severe disability. In the non-hemorrhagic group, proximal clipping or trapping was performed in 4/9 cases. Bypass surgery followed by proximal clipping or trapping was performed in 2/9 cases, and ITA in 1/9 case. One case showed treatment-related complication. GOS was GR in all cases.
Conclusion: Outcome in the hemorrhagic group was more severe as compared to the non-hemorrhagic group. The surgical strategy should be planned according to the location of the aneurysm and the origin of PICA.
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References
Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188
Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631
Mizutani T, Aruga T, Kirino T et al (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–913
Kitanaka C, Tanaka J, Kuwahara M et al (1994) Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80:667–674
Mokri B, Houser OW, Sandok BA et al (1988) Spontaneous dissections of the vertebral arteries. Neurology 38:880–885
Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28:370–374
Nakagawa K, Touho H, Morisako T et al (2000) Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings. J Neurosurg 93:19–25
Naito I, Iwai T, Sasaki T (2002) Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage. Neurosurgery 51:930–938
Lylyk P, Cohen JE, Ceratto R et al (2001) Combined endovascular treatment of dissecting vertebral artery aneurysms by using stent and coils. J Neurosurg 94:427–432
MacKay CI, Han PP, Albuquerque FC et al (2003) Recurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report. Neurosurgery 53: 754–759
Yasui T, Komiyama M, Nishikawa M et al (2000) Subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature. Neurosurgery 46:196–201
Iihara K, Sakai N, Murao K, et al (2002) Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97: 259–267
Naito I, Takatama S, Miyamoto N et al (2005) Treatment of unruptured vertebral artery dissecting aneurysms. Surg Cereb Stroke 33:406–413
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Takemoto, K., Abe, H., Uda, K., Inoue, T. (2010). Surgical Treatment of Intracranial VA Dissecting Aneurysm. In: Surgical Management of Cerebrovascular Disease. Acta Neurochirurgica Supplementum, vol 107. Springer, Vienna. https://doi.org/10.1007/978-3-211-99373-6_8
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DOI: https://doi.org/10.1007/978-3-211-99373-6_8
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