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Management of spontaneous haemorrhagic intracranial vertebrobasilar dissection: review of 21 consecutive cases

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Summary

Introduction. Haemorrhagic intracranial vertebrobasilar dissection is an uncommon cause of nontraumatic subarachnoid haemorrhage (SAH) and accounts for only 1–10% of non-traumatic SAH. Treatment in the acute phase is considered to be essential because of the high risk of rebleeding and the consequent unfavourable outcome. However, the location, the potential for involvement of eloquent vessels and the histopathological characteristics of the vessel wall make treatment demanding from both a technical and anatomical point of view. We report our experience in the management of this disease.

Patients and treatments. From 1989 to June 2006, we managed 21 patients with spontaneous haemorrhagic dissection located in the intracranial vertebrobasilar system, 13 patients were treated using an endovascular approach, 1 by surgical clipping, and 7 were managed conservatively.

Results. Among the 13 patients treated endovascularly, 7 underwent proximal occlusion, 4 underwent parent artery embolization at the site of dissection, and 2 underwent endovascular trapping. Severe, treatment-related complications due to dislodgement of the thrombus during the procedure occurred in 1 patient, who then died from brainstem ischaemia. One patient died from severe pneumonia and one patient was left disabled from vasospastic ischaemia resulting from severe initial SAH. The remaining 10 patients had satisfactory outcomes: none rebled after treatment and when discharged they had Karnovsky scores of 80–100.

Of the 7 conservatively treated patients, three died of rebleeding and four were discharged with Karnovsky scores of 50–100. One patient, who was treated surgically, was discharged with a Karnovsky of 90.

Conclusion. The high rate of rebleeding and consequent mortality among the patients treated conservatively argues for treatment in the acute phase. Treatment should be guided by each patient’s angiomorphology, clinical condition and the experience of the neurosurgical/neuroradiological team. Options include endovascular or surgical trapping of the dissection and proximal occlusion and embolisation of the parent artery at the site of the dissection.

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References

  • M Abe K Tabuchi H Yokoyama A Uchino (1998) ArticleTitleBlood blister-like aneurysms of the internal carotid artery J Neurosurg 89 419–424 Occurrence Handle9724116 Occurrence Handle1:STN:280:DyaK1czovFGjuw%3D%3D

    PubMed  CAS  Google Scholar 

  • R Anxionnat JF de Melo Neto S Bracard JC Lacour C Pinelli T Civit L Picard (2003) ArticleTitleTreatment of haemorrhagic intracranial dissections Neurosurgery 53 289–301 Occurrence Handle12925243 Occurrence Handle10.1227/01.NEU.0000073417.01297.93

    Article  PubMed  Google Scholar 

  • N Aoki T Sakai (1990) ArticleTitleRebleeding from intracranial dissecting aneurysm in the vertebral artery Stroke 21 1628–1631 Occurrence Handle2237959 Occurrence Handle1:STN:280:DyaK3M%2FkvVKqug%3D%3D

    PubMed  CAS  Google Scholar 

  • K Chifumi E Tsuneyoshi T Akira N Makoto H Katsumi (1994) ArticleTitleIntracranial vertebral artery dissections: clinical, radiological features, and surgical considerations Neurosurgery 34 IssueID4 620–627 Occurrence Handle10.1227/00006123-199404000-00008

    Article  Google Scholar 

  • CG Drake SJ Peerless (1997) ArticleTitleGiant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992 J Neurosurg 87 141–162 Occurrence Handle9254076 Occurrence Handle1:STN:280:DyaK2szps1Sruw%3D%3D

    PubMed  CAS  Google Scholar 

  • VV Halbach RT Higashida CF Dowd KW Fraser TP Smith GP Teitelbaum CB Wilson GB Hieshima (1993) ArticleTitleEndovascular treatment of vertebral artery dissections and pseudoaneurysms J Neurosurg 79 183–191 Occurrence Handle8331398 Occurrence Handle1:STN:280:DyaK3szit1Oktw%3D%3D

    PubMed  CAS  Google Scholar 

  • J Hamada Y Kai M Morioka S Yano T Todaka Y Ushio (2003) ArticleTitleMultimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage J Neurosurg 99 960–966 Occurrence Handle14705721

    PubMed  Google Scholar 

  • RA Hanel AS Boulos EG Sauvageau EI Levy LR Guterman LN Hopkins (2005) ArticleTitleStent placement for the treatment of nonsaccular aneurysms of the vertebrobasilar system Neurosurg Focus 18 1–9

    Google Scholar 

  • T Inagawa K Kamiya H Ogasawara T Yano (1987) ArticleTitleRebleeding of ruptured intracranial aneurysms in the acute stage Surg Neurol 28 IssueID2 93–99 Occurrence Handle3603360 Occurrence Handle10.1016/0090-3019(87)90079-6 Occurrence Handle1:STN:280:DyaL2s3msVSgtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • Y Inui Y Oiwa T Terada K Nakakita I Kamei S Hayashi (2006) ArticleTitleDe novo vertebral artery dissecting aneurysm after contralateral vertebral artery occlusion. Two case reports Neuro Med Chir (Tokyo) 46 32–36 Occurrence Handle10.2176/nmc.46.32

    Article  Google Scholar 

  • K Irikura Y Miyasaka H Ohtaka K Yada R Hirose (1989) ArticleTitleDissecting aneurysm of the vertebral artery with lateral medullary syndrome. A case report, with special reference to surgical treatment No Socchu 11 133–139

    Google Scholar 

  • Y Kai JI Hamada M Morioka T Todaka T Mizuno Y Ushio (2003) ArticleTitleEndovascular coil trapping for ruptured vertebral artery dissecting aneurysms by using double microcatheters technique in the acute stage Acta Neurochir (Wien) 145 447–451 Occurrence Handle1:STN:280:DC%2BD3szgs1Cmsg%3D%3D

    CAS  Google Scholar 

  • T Kawamata T Tanikawa M Takeshita H Onda K Takakura C Toyoda (1994) ArticleTitleRebleeding of intracranial dissecting aneurysm in the vertebral artery following proximal clipping Neurol Res 16 141–144 Occurrence Handle7914000 Occurrence Handle1:STN:280:DyaK2czitlShtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • C Kitanaka T Morimoto T Sasaki K Takakura (1992) ArticleTitleRebleeding from vertebral artery dissection after proximal clipping. Case report J Neurosurg 77 466–468 Occurrence Handle1506896 Occurrence Handle1:STN:280:DyaK38zntleitA%3D%3D

    PubMed  CAS  Google Scholar 

  • T Krings FJ Hans W Moller-Hartmann A Brunn R Thiex T Schmitz-Rode P Verken K Scherer H Dreeskamp KP Stein J Gilsbach A Thron (2005) ArticleTitleTreatment of experimentally induced aneurysms with stent Neurosurgery 56 1347–1360 Occurrence Handle15918952 Occurrence Handle10.1227/01.NEU.0000159887.03290.D1

    Article  PubMed  Google Scholar 

  • T Krings RL Piske P Lasjaunias (2005) ArticleTitleIntracranial arterial aneurysm vasculopathies: targeting the outer vessel wall Neuroradiology 47 931–937 Occurrence Handle16136262 Occurrence Handle10.1007/s00234-005-1438-9

    Article  PubMed  Google Scholar 

  • Y Kubo K Miura M Suzuki K Tsuiki N Kuwata N Kubo K Kuroda A Ogawa (1998) ArticleTitleDevelopment of a dissecting aneurysm on the vertebral artery immediately after occlusion of the contralateral vertebral artery: a case report Neurosurg Rev 21 177–180 Occurrence Handle9795957 Occurrence Handle10.1007/BF02389328 Occurrence Handle1:STN:280:DyaK1M%2Fht1Snuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • AK Kunze A Annecke F Wigger C Lichy F Buggle H Schnippering P Schnitzler AJ Grau (2000) ArticleTitleRecent infection as a risk factor for intracerebral and subarachnoid haemorrhages Cerebrovasc Dis 10 352–358 Occurrence Handle10971020 Occurrence Handle10.1159/000016090 Occurrence Handle1:STN:280:DC%2BD3cvotFOqsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • P Lasjaunias A Berenstein KG Ter Brugge (2001) Surgical neuroangiography SeriesTitleClinical vascular anatomy and variations NumberInSeries1 Springer Berlin Heidelberg 259–260

    Google Scholar 

  • P Lasjaunias (1997) Vascular diseases in neonates, infants and children: interventional neuroradiology management Springer Berlin Heidelberg 381

    Google Scholar 

  • DC Lelong M Logak (2004) ArticleTitlePathogenesis of spontaneous cervico-cerebral artery dissection. A hypothesis and a review of the literature Medical hypotheses 62 453–457 Occurrence Handle14975522 Occurrence Handle10.1016/j.mehy.2003.10.006 Occurrence Handle1:STN:280:DC%2BD2c%2Fos1KgtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • CI MacKay PP Han FC Albuquerque CG McDougall (2003) ArticleTitleRecurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report Neurosurgery 53 754–761 Occurrence Handle12943592 Occurrence Handle10.1227/01.NEU.0000080065.49651.48

    Article  PubMed  Google Scholar 

  • A Mahmood M Dujovny M Torche L Dragovic JI Ausman (1991) ArticleTitleMicrovascular anatomy of foramen caecum medulla oblongatae J Neurosurg 75 299–304 Occurrence Handle2072169 Occurrence Handle1:STN:280:DyaK3MzgtlagsA%3D%3D

    PubMed  CAS  Google Scholar 

  • T Mizutani T Aruga T Kirino Y Miki I Saito T Tsuchida (1995) ArticleTitleRecurrent subarachnoid haemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms Neurosurgery 36 905–913 Occurrence Handle7791980 Occurrence Handle10.1097/00006123-199505000-00003 Occurrence Handle1:STN:280:DyaK2Mzht1WqsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • T Mizutani H Kojima S Asamoto Y Miki (2001) ArticleTitlePathological mechanism and three-dimensional structure of cerebral dissecting aneurysms J Neurosurg 94 712–717 Occurrence Handle11354401 Occurrence Handle1:STN:280:DC%2BD3M3lsF2iug%3D%3D

    PubMed  CAS  Google Scholar 

  • RL Piske R Darwich CMS Campos NC Fonseca E Oliveira A Souza (1998) ArticleTitleSpontaneous resolution of a ruptured dissecting PICA aneurysm. Report of two cases Interv Neuroradiol 4 IssueID4 287–292 Occurrence Handle1:STN:280:DC%2BC3cjhs12ktg%3D%3D Occurrence Handle20673424

    CAS  PubMed  Google Scholar 

  • JD Rabinov FR Hellinger PP Morris CS Ogilvy CM Putman (2003) ArticleTitleEndovascular management of vertebrobasilar dissecting aneurysms AJNR 24 IssueID7 1421–1428 Occurrence Handle12917140

    PubMed  Google Scholar 

  • J Rosenorn V Eskesen K Schmidt F Ronde (1987) ArticleTitleThe risk of rebleeding from ruptured intracranial aneurysms J Neurosurg 67 IssueID3 329–332 Occurrence Handle3612265 Occurrence Handle1:STN:280:DyaL2s3ot1Khug%3D%3D

    PubMed  CAS  Google Scholar 

  • D Rothbart RF Spetzler (1996) ArticleTitleIntracranial vertebral artery dissections Crit Rev Neurosurg 6 195–201

    Google Scholar 

  • O Sasaki H Ogawa T Koike T Koizumi R Tanaka (1991) ArticleTitleA clinicopathological study of dissecting aneurysms of the intracranial vertebral artery J Neurosurg 75 874–882 Occurrence Handle1941116 Occurrence Handle1:STN:280:DyaK38%2FksVyhsA%3D%3D

    PubMed  CAS  Google Scholar 

  • M Sawada Y Kaku S Yoshimura M Kawaguchi T Matsuhisa T Hirata T Iwama (2005) ArticleTitleAntegrade recanalization of a completely embolized vertebral artery after endovascular treatment of a ruptured intracranial dissecting aneurysm: report of two cases J Neurosurg 102 161–166 Occurrence Handle15658109

    PubMed  Google Scholar 

  • WI Schievink EFM Wijdicks JD Kuiper (1998) ArticleTitleSeasonal pattern of spontaneous cervical artery dissection J Neurosurg 89 101–103 Occurrence Handle9647179 Occurrence Handle1:STN:280:DyaK1czgvFeqtg%3D%3D Occurrence Handle10.3171/jns.1998.89.1.0101

    Article  PubMed  CAS  Google Scholar 

  • B Voldby EM Enevoldsen (1982) ArticleTitleIntracranial pressure changes following aneurysm rupture. Part 3: Recurrent haemorrhage J Neurosurg 56 IssueID6 784–789 Occurrence Handle7077377 Occurrence Handle1:STN:280:DyaL387ptFyisw%3D%3D

    PubMed  CAS  Google Scholar 

  • JD Wenderoth MS Khangure CC Phatouros HT ApSimon (2003) ArticleTitleBasilar trunk occlusion during endovascular treatment of giant and fusiform aneurysms of the basilar artery AJNR 24 1226–1229 Occurrence Handle12812959

    PubMed  Google Scholar 

  • A Yamaura Y Watanabe N Saeki (1990) ArticleTitleDissecting aneurysms of the intracranial vertebral artery J Neurosurg 72 183–188 Occurrence Handle2404089 Occurrence Handle1:STN:280:DyaK3c7htFyhtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • I Yamaura E Tani M Yokota A Nakano M Fukami K Kaba T Matsumoto (1999) ArticleTitleEndovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils J Neurosurg 90 853–856 Occurrence Handle10223450 Occurrence Handle1:STN:280:DyaK1M3jsl2lsw%3D%3D

    PubMed  CAS  Google Scholar 

  • T Yasui H Kishi M Komiyama Y Iwai K Yamanaka M Nishikawa H Nakajima T Morikawa (2000) ArticleTitleRerupture mechanism of ruptured intracranial dissecting aneurysm in the vertebral artery following proximal occlusion No Shinkei Geka 28 IssueID4 345–349 Occurrence Handle10769833 Occurrence Handle1:STN:280:DC%2BD3c3jt1KltA%3D%3D

    PubMed  CAS  Google Scholar 

  • T Yasui M Komiyama M Nishikawa H Nakajima (2000) ArticleTitleSubarachnoid haemorrhage 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 Occurrence Handle10626950 Occurrence Handle10.1097/00006123-200001000-00038 Occurrence Handle1:STN:280:DC%2BD3c%2FptVektA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • H Yonas D Agamanolis Y Takaoka RJ White (1977) ArticleTitleDissecting intracranial aneurysms Surg Neurol 8 407–415 Occurrence Handle594878 Occurrence Handle1:STN:280:DyaE1c%2FnsFWrtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • I Yuki Y Murayama F Vinuela (2005) ArticleTitleEndovascular management of dissecting vertebrobasilar artery aneurysms in patients presenting with acute subarachnoid haemorrhage J Neurosurg 103 IssueID4 649–655 Occurrence Handle16266047 Occurrence Handle10.3171/jns.2005.103.4.0649

    Article  PubMed  Google Scholar 

  • WY Zhao T Krings H Alvarez A Ozanne S Holmin PL Lasjaunias (2006) ArticleTitleSpontaneous mirror dissections of cervicocephalic arteries: pathomechanical considerations Interv Neuroradiol 12 73–78 Occurrence Handle1:STN:280:DC%2BC3crkt1GqtA%3D%3D Occurrence Handle20569557

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neuroradiologie Vasculaire Diagnostique et Thérapeutique, Hôpital Bicêtre, Le Kremlin Bicêtre, France

    W. Y. Zhao, T. Krings, H. Alvarez, A. Ozanne, S. Holmin & P. Lasjaunias

  2. Department of Neurosurgery, Changhai Hospital, Shanghai, China

    W. Y. Zhao

  3. Department of Neuroradiology, University Hospital of the Technical University, Aachen, Germany

    T. Krings

  4. Section for Neuroradiology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

    S. Holmin

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  1. W. Y. Zhao
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Zhao, W., Krings, T., Alvarez, H. et al. Management of spontaneous haemorrhagic intracranial vertebrobasilar dissection: review of 21 consecutive cases. Acta Neurochir (Wien) 149, 585–596 (2007). https://doi.org/10.1007/s00701-007-1161-x

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