Giant pseudoaneurysm of the extracranial vertebral artery: case report

Abstract

-Pseudoaneurysms of the extracranial vertebral artery are extremely rare due to their deep location and the anatomical protection of this artery. They can be caused by cervical traumas (firearm injuries, sports, hyperextension of the neck and iatrogeny). The authors report the case of a patient who developed a giant pseudoaneurysm of the extracranial vertebral artery after surgery for the removal of a tumor of the cerebellopontine angle in which surgical lesion of the artery occurred. Treatment was performed by endovascular approach. Literature is reviewed and comments are made on the physiopathogeny of the lesion and the different forms of treatment. KEY WORDS: aneurysm, vertebral artery aneurysm.endovascular treatmentPseudoaneurisma gigante da artéria vertebral extracraniana: relato de caso RESUMO -Os pseudoaneurismas da artéria vertebral extracraniana são extremamente raros pela localização profunda e proteção anatômica desta artéria. Podem ser ocasionados por traumas cervicais (ferimentos por armas de fogo, esportes, hiperextensão do pescoço e iãtrogenias). Os autores relatam o caso de um paciente que desenvolveu um pseudoaneurisma gigante da artéria vertebral extracraniana após cirurgia para retirada de tumor de ângulo ponto cerebelar em que ocorreu a lesão cirúrgica desta artéria e cujo tratamento foi endovascular. A literatura é revisada e são feitas considerações sobre a fisiopatogenia da lesão e as várias formas de tratamento. PALAVRAS-CHAVE: aneurisma, aneurisma da artéria vertebral, tratamento endovascularPseudoaneurysms of the extracranial vertebral artery are rare lesions 5 -36 since this artery is anatomically protected 20 . The initial description was made by Matas in 1893 32 , and there are few reports of iatrogenic pseudoaneurysms. The resolution of these lesions is rather controversial, always with a high degree of difficulty and various rates of morbidity and mortality 3 '

Isolated temporal infarct due traumatic vertebral artery dissecting pseudo-aneurysm: a rare case report

“…The most prevalent cause of this situation is blunt or penetrating trauma [ 3 , 5 8 ], which generally necessitate a significant surgical surgery [8] . Due to the vertebral artery's relatively protective placement within the transverse foramina of the cervical vertebrae, traumatic vertebral arteriolar artery damage is uncommon [3] , [4] , [5] . Direct artery damage from a foreign body or bone fragments as a result of a skull fracture, or vascular twisting, stretching, and pressure against neighboring tissues are the mechanisms [6] .…”

“…Extracranial vertebral artery injuries are uncommon [3] , owing to the artery's deep placement and anatomical protection [ 4 , 5 ]. Because of the high risk of rebleeding or regrowth, traumatic pseudoaneurysm ruptures are linked with a high mortality rate [6] , whereas vertebral arterial dissection (VAD) and carotid artery dissections may account for 25%-30% of ischemic strokes in people below the age of 50 years [7] .…”

Extracranial Vertebral Artery Aneurysm: An Unpleasant Consequence of Neck Massage

“…Extracranial VA aneurysms are rare and usually occur following trauma. [ 1 2 ] They commonly occur as a result of dissection that may be caused by penetrating[ 1 2 ] and rarely blunt trauma. [ 1 ] Usually, the dissection takes place at the most mobile and unprotected segment of the VA – the atlantal segment (between transverse foramen of C2 and till it enters the dura).…”

“…As with our patient, other reports too describe patients with a pulsatile cervical mass. [ 2 4 ] Modes of presentation may vary from cervical radiculopathy, ischemic strokes, subarachnoid hemorrhage, cranial neuropathies, and cerebellar features. [ 2 5 ]…”

“…Treatment modalities include excision of the aneurysm with ligation of the parent vessel,[ 1 2 5 ] excision with repair of the VA,[ 5 6 ] arterial bypass with trapping of the aneurysm and excision,[ 2 6 ] stenting the vessels,[ 5 ] embolization of the aneurysm[ 3 ] or parent vessel,[ 2 5 ] and flow diverters. [ 5 ] Of these, ligation of the VA is the most common procedure undertaken if the contralateral VA is patent.…”