Therapeutic Results of Dissecting Aneurysms of Vertebral Artery.

Lee, Eung Jae; Shin, Yong Sam; Ahn, Young Hwan; Yoon, Soo Han; Cho, Ki Hong; Cho, Kyung Gi

Original Article

Journal of Korean Neurosurgical Society 2004;36(1): 40-45.

Eung Jae Lee, Yong Sam Shin, Young Hwan Ahn, Soo Han Yoon, Ki Hong Cho, Kyung Gi Cho

Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea. nsshin@ajou.ac.kr

ABSTRACT

OBJECTIVE
We present a retrospective analysis of clinical characteristics of vertebral artery dissecting aneurysms and efficacy of treatment outcome according to the various treatment modalities. METHODS: From March 2001 to February 2002, seven patients with dissecting aneurysm of vertebral artery were diagnosed by cerebral angiography. Five patients presented with subarchnoid hemorrhage and two patients with mass effect. Five patients were treated endovascularly using Guglielmi detachable coils and a patient with severe brainstem compression underwent direct surgery. Another patient rebled before treatment and subsequently died.
RESULTS
We had no endovascular procedure-related complications. Four patients with subarachnoid hemorrhage who underwent endovascular treatment survived with good recovery. One of them rebled after initial treatment and was treated by additional endovascular procedure. Among patients with mass effect, one patient was treated with proximal occlusion of vertebral artery and another underwent complete excision of aneurysm, with anastomosis of the PICA into the dissecting aneurysm proximal portion. We obtained a good treatment results with improvement of myelopathy in both patients, however, the patients who had underwent bypass surgery suffered from transient lower cranial nerve palsy.
CONCLUSION
The endovascular treatment for vertebral artery dissecting aneurysm could be the treatment of choice for these lesions to prevent early rebleeding and obtain optimal results. However, the choice for the treatment modality in such lesions should be determined according to the individual lesions considering the status of patients, clinical characteristics, and relation with posterior inferior cerebellar artery.

Key Words: Dissecting aneurysm; Vertebral artery; GDC; Endovascular treatment