Classification and Treatment of Vertebral Dissecting Aneurysm

Sano, Hirotoshi; Kato, Yōkō; Okuma, Isao; Yamaguchi, Sachiko; Ninomiya, Takashi; Arunkumar, R; Kanno, Tetsuo

doi:10.1016/s0090-3019(97)00022-0

Cited by 31 publications

(7 citation statements)

References 13 publications

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“…Direct clipping may be preferable in cases with unilateral aneurysms and VA reconstruction was successful in 8 of 16 patients reported by Sano H et al6…”

Section: Discussionmentioning

confidence: 91%

“…In one series, brain stem infarction occurred in 1 of 16 patients 6. Although VA reconstruction is difficult, blood flow through parent arteries should be preserved as much as possible 6…”

Section: Discussionmentioning

confidence: 99%

“…The first step in clinical management of spontaneous dissecting aneurysm of the intracranial VA is to recognize early symptoms and to make the correct initial diagnosis based on characteristic symptomatology 6. Patients usually present with a variable combination of neck pain or headache, transient loss of consciousness, SAH, and embolic stroke 7.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Kitanaka C et al, 16 out of 24 patients treated during the last 12 years were admitted with SAH 14. Fourteen of 16 patients reported by Sano H et al developed SAH, and 4 of these 14 patients complained of headaches for several days (2-10 days) prior to the onset of SAH 6. Although in one series where the preoperative rebleeding rate was not very high (4 of 16, 25%) probably because many patients underwent early surgery,14 subsequent rebleeding is thought to occur frequently especially within 24 hours in ruptured lesions 12.…”

Section: Discussionmentioning

confidence: 99%

“…For many years, spontaneous dissecting aneurysms of the intracranial vertebral artery (VA) were believed to be quite rare; however these aneurysms are now being reported more frequently and are increasingly recognized as a source of appreciable morbidity and mortality 1-6. Since these lesions can be difficult to diagnose on an angiography and clinical manifestations may be delayed or overlooked, their prevalence is not precisely known 7.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Dissecting Aneurysm of the Intracranial Vertebral Artery: Management Strategies

Lee

Jung

Kim³

et al. 2007

Yonsei Med J

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PurposePathogenesis 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.Materials and MethodsAmong 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.ResultsFor 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.ConclusionRuptured 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.

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“…Direct clipping may be preferable in cases with unilateral aneurysms and VA reconstruction was successful in 8 of 16 patients reported by Sano H et al6…”

Section: Discussionmentioning

confidence: 91%

“…In one series, brain stem infarction occurred in 1 of 16 patients 6. Although VA reconstruction is difficult, blood flow through parent arteries should be preserved as much as possible 6…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Spontaneous Dissecting Aneurysm of the Intracranial Vertebral Artery: Management Strategies

Lee

Jung

Kim³

et al. 2007

Yonsei Med J

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Hemorrhagic cerebral dissecting aneurysms: surgical treatments and results

Yonekawa¹,

Zumofen²,

Imhof³

et al.

Acta Neurochirurgica Supplements

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A Study of Vertebrobasilar Artery Dissection with Subarachnoid Hemorrhage

Nakajima

Terauchi

Minematsu

2009

Acta Neurochirurgica Supplementum

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We retrospectively studied clinical characteristics of 368 patients with cerebral artery dissections who were diagnosed in 172 Japanese hospitals. Of these patients, 130 (35%) presented with subarachnoid hemorrhage, 217 (59%) with cerebral infarctions, and 21 (6%) with transient ischemic attacks. We analyzed 109 (84%) subarachnoid hemorrhage cases caused by vertebrobasilar artery dissection to evaluate conservative and surgical treatment from the viewpoint of postoperative rerupture and infarction.Subsequent ruptures were observed in 14% of the 21 cases with nonsurgical treatment. For the preventive purpose of rerupture, 88 patients received surgical interventions: 68 trappings, 13 proximal occlusions, 6 aneurysmal sac occlusions and 1 stenting. Rerupture was experienced in 33% of the aneurysmal sac occlusion patients while not occurring in the other three surgical interventions. In the group without vascular anastomosis, postoperative cerebral infarction was observed in 25% of the trapping, none of the proximal occlusion and 33% of the aneurysmal sac occlusion cases.In this study, aneurysmal sac occlusion treatments were more frequently complicated by rerupture or cerebral infarction postoperatively than the other treatment methods. It was difficult to determine which surgical treatment can achieve better surgical outcome among the proximal occlusion and trapping with or without vascular anastomosis.

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Classification and Treatment of Vertebral Dissecting Aneurysm

Cited by 31 publications

References 13 publications

Spontaneous Dissecting Aneurysm of the Intracranial Vertebral Artery: Management Strategies

Spontaneous Dissecting Aneurysm of the Intracranial Vertebral Artery: Management Strategies

Hemorrhagic cerebral dissecting aneurysms: surgical treatments and results

A Study of Vertebrobasilar Artery Dissection with Subarachnoid Hemorrhage

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