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[Treatment for the ruptured bilateral vertebral dissecting aneurysms]
Ken Somekawa1, Kazuya Nagata, Shunsuke Kawamoto
1Department of Neurosurgery, Showa General Hospital, 2-450 Tenjincho, Kodaira, Tokyo 187-8510, Japan.
No Shinkei Geka. Neurological Surgery
|March 22, 2002
Summary
Bilateral vertebral dissecting aneurysms causing subarachnoid hemorrhage are rare. A case demonstrates that treating one side may worsen the other, suggesting aggressive bilateral treatment is necessary.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Neuroradiology
Background:
- Vertebral artery dissecting aneurysms can lead to subarachnoid hemorrhage.
- Bilateral involvement is uncommon but poses unique management challenges.
Observation:
- A patient presented with bilateral vertebral dissecting aneurysms and subarachnoid hemorrhage.
- Initial treatment involved proximal ligation of the ruptured vertebral artery and wrapping of the contralateral dissection.
Findings:
- The patient experienced fatal rebleeding despite initial treatment.
- Postoperative angiography revealed enlargement of the contralateral dissection, suggesting it ruptured.
- Hemodynamic shifts from unilateral occlusion may have exacerbated the contralateral dissection.
Implications:
- Simple wrapping is insufficient for contralateral dissections.
- Radical surgical approaches, including bilateral vertebral artery occlusion and vascular reconstruction, may be superior.
- This case highlights the complex pathophysiology and treatment considerations for bilateral vertebral artery dissections.