Summary
We analysed the clinical presentation, treatment and outcome of our own 36 cases of posterior circulation dissecting aneurysms (DA) and discussed the surgical indications and procedures regarding posterior fossa DA. Twenty one cases were male, 15 cases were female. Their mean age was 54±14 years. Clinical manifestations were subarachnoid haemorrhage (SAH) in 14 cases (39%) and ischaemic attacks in 22 cases (61%). Three of 14 SAH cases had rebleeding in the acute stage. Angiographic findings were aneurysmal dilatation in 16 cases, retention of contrast medium in 12 cases, string sign in 9 cases, double lumen in 4 cases, pearl and string sign in 3 cases, and occlusion of parent artery in 2 cases. Surgical treatment was performed on nineteen cases (53%). The operation was carried out in the acute stage on the SAH group; in the subacute or chronic stage on the ischaemic group. The surgical procedure was the proximal ligation, trapping and removal of DA with or without revascularization of the parent artery. 84% of the surgically managed patients and 71% of the nonsurgical cases had a favourable outcome (good recovery or moderate disability). Poor prognosis was revealed from the rebleeding and primary neurological stage. We recommend surgical treatment in the acute stage on the SAH group. On the ischaemic group surgical treatment in the subacute or chronic stage is recommended, if the DA has the risk of rupture or progression of the dissection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21: 1628–1631
Berger MS, Wilson CB (1984) Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61: 882–894
Dimsdale H, Logue V (1959) Ruptured posterior fossa aneurysm and their surgical treatment. J Neurol Neurosurg Psychiatry 22: 202–217
Drake CG, Hunt WE, Sano K, Kassell N, Teasdale G, Pertuiset B, DeVilliers JC (1988) Report of World Federation of Neurological Surgeons Committe Universal Subarachnoid Haemorrhage Grading Scale. J Neurosurg 68: 985–986
Friedman AH, Drake CG (1984) Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60: 325–334
Fujiwara S, Yokoyama N, Fujii K, Matsushima T, Matsubara T, Fukui M (1993) Repeat angiography and magnetic resonance imaging (MRI) of dissecting aneurysms of the intracranial vertebral artery. Acta Neurochir (Wien) 121: 123–129
Hause M, Fukuda T, Haraoka J, Miwa T (1991) An operative for the dissecting aneurysm of vertebral artery. Surg Cereb Stroke 19: 439–444
Iwama T, Andoh T, Sakai N, Iwata T, Hirata T, Yamada H (1990) Dissecting and fusiform aneurysms of vertebro-basilar systems. MR imaging. Neuroradiology 32: 272–279
Okamura K, Watanabe M, Nakamura S, Yamamoto M, Fukui K (1990) Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of literature. Jpn J Stroke 12: 369–380
Pozzati E, Padavani R, Fabrizi A, Sabattini L, Gaist G (1991) Benign arterial dissection of the posterior circulation. J Neurosurg 75: 69–72
Sakai O, Ogawa H, Koike T, Koizumi T, Tanaka R (1991) A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 78: 874–882
Scholenfield BG (1924) A case of dissecting aneurysm of basilar artery. Guys Hosp Rep 74: 874–882
Shimoji T, Bando K, Nakamura K, Ito K (1984) Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61: 1038–1064
Shintani A, Zervas NT (1972) Consequence of ligation of the vertebral artery. J Neurosurg 36: 447–450
Su CC, Watanabe T, Yoshimoto T, Ogawa A, Ichige A (1990) Proximal clipping of dissecting intracranial vertebral aneurysm. Effect of balloon matas test with neurophysiological monitoring. Acta Neurochir (Wien) 104: 59–63
Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72: 183–188
Yasui T, Yagura H, Komiyama M, Fu Y, Nagata Y, Tamura K (1993) Surgical treatment for ruptured dissecting aneurysms: proximal clipping vs. trapping. Neurol Surg 21: 395–401
Yonas H, Agamanolis D, Takaoka Y, White RJ (1977) Dissecting intracranial aneurysms. Surg Neurol 8: 407–415
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kawaguchi, S., Sakaki, T., Tsunoda, S. et al. Management of dissecting aneurysms of the posterior circulation. Acta neurochir 131, 26–31 (1994). https://doi.org/10.1007/BF01401451
Issue Date:
DOI: https://doi.org/10.1007/BF01401451