Dissecting aneurysms of the intracranial vertebral artery

Abstract

Among 86 patients with aneurysms arising from the vertebral artery or its branches, 24 had dissecting aneurysms. The patients with dissecting aneurysms were characteristically relatively young males. Twenty-one patients presented with subarachnoid hemorrhage (SAH) and three with ischemia. Severe headache or neck pain occurred in all three patients with ischemia. Five of the 21 patients with SAH and all three patients with ischemia experienced recurrent episodes. Angiography typically showed fusiform dilatation and proximal and/or distal narrowing of the affected artery. The difficulty of diagnosing this disorder is pointed out. Surgery was performed in 19 patients, the most common technique being clip-occlusion of the proximal vertebral artery. There were no postoperative deaths or rebleeding; a lateral medullary syndrome developed in three patients. The observation at surgery of intramural clot with characteristic discoloration was limited to the cases operated on within 36 days after the ictus. After this period, the aneurysm was whitish gray in color and had become firm. Of 36 other cases of vertebral dissecting aneurysm reported in the literature, 20 were operated on. The indications for surgery are discussed.

Long-Term Follow Up of Antegrade Recanalization of Vertebral Artery Dissecting Aneurysm After Internal Trapping -Case Report-

“…13,26,27) In the present case, the lesion was not confirmed by direct surgery or pathological examination. We also did not perform three-dimensional CT angiography or MR angiography before internal trapping.…”

“…1,13,26,27) Most dissections rebleed during the acute phase, 1,13,26,27) so emergent surgical internal trapping of the parent artery is recommended. 4,6,7,[9][10][11]20,23,29) However, the rate of rebleeding decreases during the chronic stage because of the spontaneous resolution of the dissecting walls of the VA. 14,15,19) Antegrade recanalization in the parent artery occasionally occurs after internal trapping.…”

Caracterizacion de las Ramas del Arco Aórtico en una Muestra de Poblacion Colombiana: Un Estudio con Material de Autopsia

“…Se señala una mayor incidencia estadísticamente significativa de disección de la pared vascular de la AVI que causa isquemia cerebral cuando se origina directamente del AA, con relación a la que se presenta del lado derecho (Yamaura et al, 1990). Esto puede explicarse por defecto congénito estructural de la pared y las alteraciones del flujo cerebral pul-…”

High Incidence of Arterial Dissection Associated With Left Vertebral Artery of Aortic Origin.

“…3,7,15,18) Extracranial VA dissection causes brain ischemia, and intracranial dissection causes either subarachnoid hemorrhage or brain ischemia. Vascular anomalies of the VA, including fenestration, duplication, abnormal course, or abnormal origin, are occasionally associated with intracranial vascular lesions, such as cerebral aneurysms, arteriovenous malformation, arterial dissection, and moyamoya disease.…”