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Dissecting intracranial vertebral artery aneurysms.
R N Bhattacharya1, G Menon, S Nair
1Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695011, India. rnb@sctimst.ker.nic.in
Neurology India
|January 19, 2002
Summary
Dissecting intracranial artery aneurysms are rare but deadly. Surgical trapping and excision of the affected segment, especially for vertebral artery aneurysms, offers successful outcomes with potential for recovery.
Area of Science:
- Neurology
- Vascular Surgery
- Neuroradiology
Background:
- Dissecting aneurysms of intracranial arteries are rare vascular lesions.
- These aneurysms can cause acute cerebral or brainstem infarction in young adults.
- They are associated with a high mortality rate.
Observation:
- Two cases of dissecting vertebral artery aneurysms presenting with hemorrhage were successfully treated.
- Both aneurysms were located distal to the origin of the posterior inferior cerebellar artery (PICA).
- Postoperative complications included lower cranial nerve paresis and lateral medullary syndrome, which subsequently improved.
Findings:
- Surgical management by trapping and excision of the dissecting segment is effective for bleeding dissecting aneurysms.
- Preserving the PICA origin during surgery is crucial.
- Interventional radiological techniques are also viable treatment options.
Implications:
- For cases where the PICA origin is involved in the trapped segment, revascularization procedures should be considered alongside trapping.
- The management of dissecting vertebral artery aneurysms presents diagnostic and therapeutic challenges.
- Reviewing management controversies is essential for optimizing patient care.