Direct Surgery for Dissecting Vertebral Aneurysms Involving PICA

Summary:In ruptured intracranial arterial dissection of the vertebrobasilar system, subsequent rupture is one of the poor prognostic factors. We analyzed the factors related to the subsequent rupture and compared the surgical results of craniotomy with those of intravascular surgery. Among 154 patients with vertebrobasilar arterial dissection, 92 presented with subarachnoid hemorrhage.Fifty-six patients were surgically treated: 35 had craniotomies (proximal occlusion or trapping), and 21 had intravascular surgery (internal trapping or proximal occlusion).Subsequent rupture occurred in 29% (27/92), and was observed mostly on the day of onset. Among the various clinical and radiological factors, a history of arterial hypertension, a poor Hunt and Kosnik grade (3-5), and a pearl and string sign on the angiogram were significantly more frequent in the patients with subsequent rupture. The long-term outcomes in the craniotomy group were generally equal to those in the intravascular group. When the analysis was limited to acute stage, the results of the surgical treatment were unchanged between the 2 groups. In addition, the incidence of postoperative ischemic complication did not differ significantly between the 2 groups.These results suggest that a history of arterial hypertension, a poor Hunt and Kosnik grade and the pearl and string sign are significant factors correlated with subsequent rupture. Surgical treatment may be indicated for patients with the above 3 factors, both craniotomy and intravascular surgery.

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Coil Embolization for Dissecting Aneurysms of the Vertebral Artery Preserving Perforating Arteries to the Medulla Oblongata

齊木¹,

佐藤²,

山田³

et al. 2011

Surg. Cereb. Stroke

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In this paper, we retrospectively analyze the factors related to infarction of the medulla oblongata causing Wallenberg syndrome after endovascular trapping for dissecting aneurysm of the vertebral artery (VA). Seven cases of dissecting aneurysm of the VA including 5 ruptured cases were treated with endovascular coil embolization between 2003 and 2009 in our hospital. The posterior inferior cerebellar arteries (PICA) originated proximal to the aneurysm in 1 case, at the site of the aneurysm in 1 case, distal in 2 cases, and from the basilar artery (BA) in 3 cases. Complete obliteration of the dissecting aneurysms preserving blood flow of the PICA and opposite VA could be obtained in all cases except 1 case in which the aneurysm involved the PICA. No rebleeding was experienced, but infarction of the lateral medulla occurred in all 3 cases in which the PICA originated from the BA. Though the outcome of the 3 cases was favorable (mRS 0-2; 100%), surgeons should be aware of the risk of the trapping of the VA if the PICA originate from the BA.

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Direct Surgery for Dissecting Vertebral Aneurysms Involving PICA

Abstract: We discuss options, techniques, pitfalls, and risk and benefits of surgical treatments for dissecting vertebral aneurysms involving the posterior inferior cerebellar artery (PICA). Our discussion is based on recent experience of 12 cases over a 5-year period of direct trapping for ruptured

Cited by 5 publications

References 21 publications

VI. Other Types of Cerebrovascular Disorders

VI. Other Types of Cerebrovascular Disorders

Subarachnoid Hemorrhage from Intracranial Arterial Dissection in the Vertebrobasilar System: Factors Related to Subsequent Rupture, and Surgical Results

Coil Embolization for Dissecting Aneurysms of the Vertebral Artery Preserving Perforating Arteries to the Medulla Oblongata

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