Management of dissecting aneurysms of the posterior circulation

Abstract

We analysed the clinical presentation, treatment and outcome of our own 36 cases of posterior circulation dissecting aneurysms (DA) and discussed the surgical indications and procedures regarding posterior fossa DA. Twenty one cases were male, 15 cases were female. Their mean age was 54 +/- 14 years. Clinical manifestations were subarachnoid haemorrhage (SAH) in 14 cases (39%) and ischaemic attacks in 22 cases (61%). Three of 14 SAH cases had rebleeding in the acute stage. Angiographic findings were aneurysmal dilatation in 16 cases, retention of contrast medium in 12 cases, string sign in 9 cases, double lumen in 4 cases, pearl and string sign in 3 cases, and occlusion of parent artery in 2 cases. Surgical treatment was performed on nineteen cases (53%). The operation was carried out in the acute stage on the SAH group; in the subacute or chronic stage on the ischaemic group. The surgical procedure was the proximal ligation, trapping and removal of DA with or without revascularization of the parent artery. 84% of the surgically managed patients and 71% of the nonsurgical cases had a favourable outcome (good recovery or moderate disability). Poor prognosis was revealed from the rebleeding and primary neurological stage. We recommend surgical treatment in the acute stage on the SAH group. On the ischaemic group surgical treatment in the subacute or chronic stage is recommended, if the DA has the risk of rupture or progression of the dissection.

Dissecting Basilar Artery Aneurysm Growing During Long-term Follow Up. Case Report.

“…Thirty patients were admitted with SAH, 24 were admitted with brain stem ischemia, eight were asymptomatic, and two had an unknown diagnosis. Most of intracranial dissections result in ischemia as the cause of death, 6) but we found that SAH slightly outnumbered ischemia as the main cause of death. 4,17) Recurrence of bleeding in the acute stage accounted for eight cases (26.1%), which is similar to that reported for dissecting vertebral artery aneurysms (28%).…”

Top of the Basilar Syndrome in a Young Adult Initially Presenting with a Convulsive Seizure

“…However, details of the background and the optimal management for cerebral artery dissection are still unknown (10).…”

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

“…Probability of rebleeding and morbidity/ mortality rates of IDAs of the VB circulation were reported as high as 71 and 50 %, respectively [4,17,18,73,94,97,145,160]. Kawaguchi and associates [62] reported in their series of VA dissecting aneurysms 21 % rebleeding rate during the first 72 h with 100 % mortality. Yamaura et al [171] reported 24 % of rebleeding in time period from third to 17th postictus day with 80 % mortality rate.…”