A Surgical Method of Treating Vertebral Artery Dissection Intended to Prevent Medullary Infarctions Coupled with Trapping of the Lesion as Much as Possible

Abstract

A surgical method of treating vertebral artery (VA) dissection intended to prevent medullary infarctions coupled with trapping of the lesion as much as possible is described in seven consecutive patients [4 with subarachnoid hemorrhage (SAH), 3 without SAH (non-SAH)] at our hospital. Patients are first placed in the semi-prone position, then rotated to prone during lateral suboccipital craniotomy and C1 laminectomy for safety and ease of the procedure. Patients are repositioned to the semi-prone position for the micro-neurosurgery. The trans-cerebellomedullary fissure approach is used for distal VA and medullary perforating artery manipulation in the upward surgical view; thereafter, pinpoint trapping of the lesion is performed. For dissections involving the posterior inferior cerebellar artery (PICA), the PICA is reimplanted and closed in a pin-point manner, just proximal to the origin of the medullary perforating artery, which arises from the first segment of the PICA. Further improvement in the surgical method for VA dissection is needed for safer and more secure occlusion of the lesion.