Yonsei Med J.  2007 Jun;48(3):425-432. 10.3349/ymj.2007.48.3.425.

Spontaneous Dissecting Aneurysm of the Intracranial Vertebral Artery: Management Strategies

• Lee JW
• Jung JY
• Kim YB
• Huh SK
• Kim DI
• Lee KC

• KMID: 724097
• DOI: http://doi.org/10.3349/ymj.2007.48.3.425

Abstract

PURPOSE
Pathogenesis and treatment of spontaneous dissecting aneurysm of the intracranial vertebral artery (VA) remain controversial. This study was designed to provide management strategies and to improve management outcome in patients with these aneurysms. MATERIALA AND METHODS: Among a total of 1,990 patients treated for intracranial aneurysms from February 1992 to June 2005, 28 patients (1.4%) were treated either by surgery (8 patients) or neurointervention (20 patients) for spontaneous dissecting aneurysms of the intracranial VA. Twenty-two patients had ruptured aneurysms. We analyzed indications of surgery or neurointervention for each case, and assessed the management outcome at a 6-month follow-up. RESULTS: For selection of therapeutic options, patients were initially evaluated as possible candidates for neurointervention using the following criteria: 1) poor clinical grade; 2) advanced age; 3) medical illness; 4) unruptured aneurysm; 5) equal or larger opposite VA; 6) anticipated surgical difficulty due to a deep location of the VA-posterior inferior cerebellar artery (PICA) junction. Surgery was considered for patients with: 1) high-risk aneurysms (large or irregular shaped); 2) smaller opposite VA; 3) failed neurointervention; or 4) dissection involving the PICA. Management outcomes were favorable in 25 patients (89.3%). Causes of unfavorable outcome in the remaining 3 patients were the initial insult in 2 patients, and medical complications in one patient. CONCLUSION: Ruptured aneurysms must be treated to prevent rebleeding. For unruptured aneurysms, follow-up angiography would be necessary to detect growth of the aneurysm. Treatment modality should be selected according to the clinical characteristics of each patient and close collaboration between neurosurgeons and neurointerventionists is essential.

Keyword

Management strategies; spontaneous dissecting aneurysm; intracranial vertebral artery

MeSH Terms

Adult
Aged
Aneurysm, Dissecting/*pathology/surgery/therapy
Aneurysm, Ruptured/pathology/surgery/therapy
Female
Follow-Up Studies
Humans
Intracranial Aneurysm/*pathology/surgery/therapy
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Vertebral Artery/*pathology/surgery

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