Dissecting Aneurysms on Vertebral Artery and its Branches

Seo, Eui Kyo; Jun, Pyung; Cho, Yong Jae; Kim, Sang Jin

Abstract

BACKGROUND: Dissecting aneurysms of the vertebral artery are rare. Diagnosis and treatment of such condition aneurysm has a potentially higher degree of technical difficulty. The authors analyzed the clinical features and treatment modality for dissecting aneurysms arising from vertebral artery and its branches.
METHODS
At the authors'institution between April. 2001 and Sep. 2004, 18 patients were diagnosed and treated for dissecting aneurysms of vertebral artery and its branches. The medical records and neuroimaging studies of the patients were reviewed retrospectively.
RESULTS
18 patients were comprised of 8 female and 10 male patients aged from 24~69 year old (mean: 44.2). Of the 18 patients, 8 patients (44.4%) had subarachnoid hemorrhage. 6 patients with subarachnoid hemorrahge were in good neurological status before treatment. Four patients were treated with transcranial surgery and 7 patients with endovascular treatment. the other 7 patient were merely treated with conservative care. All patients were diagnosed with digital subtraction angiography (DSA), but Magnetic resonance angiography (MRA) showed 12 dissecting aneurysms, 2 suspicious cases and 3 normal finding. In the case of anterior inferior cerebellar artery (AICA) dissecting aneurysm, MR angiography showed no visible AICA. Posterior inferior cerebellar artery (PICA) was occluded in postoperative DSA after wrapping of PICA for dissecting aneurysm of proximal protion of AICA. But the patient show no neurologic deficit. One patient developed bilateral vertebral artery dissecting aneurysms. One patient treated only conservative care revealed normal DSA finding on follow-up study.
CONCLUSION
DSA is the only accurate diagnostic tool for vertebral dissecting aneurysm. Proximal GDC occlusion of vertebral artery may be a safe and effective therapy for patients with vertebral artery dissecting aneurysm. For proper decision of safe treatment modality, one should consider vertebral artery dominancy, collateral circulation, PICA invasion.