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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Surgical treatment of intracranial VA dissecting aneurysm
Koichiro Takemoto1, Hiroshi Abe, Ken Uda
1Department of Neurosurgery, Fukuoka University School of medicine, 7-45-1 Nanakuma, Jounan-ku, Fukuoka-shi, Fukuoka, 814-0180, Japan. take9016@fukuoka-.ac.jp
Insights
Intracranial vertebral artery (VA) dissections with aneurysms present significant risks. Surgical outcomes were poorer in hemorrhagic cases compared to non-hemorrhagic ones, emphasizing tailored treatment strategies.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Intracranial vertebral artery (VA) dissections are linked to severe outcomes like stroke and subarachnoid hemorrhage (SAH).
- High morbidity and mortality rates necessitate a clear understanding of clinical features and effective treatments.
Purpose of the Study:
- To elucidate the clinical characteristics of intracranial VA dissections.
- To evaluate the effectiveness of surgical treatments for these dissections.
- To present a retrospective analysis of institutional experience.
Main Methods:
- Retrospective analysis of 62 intracranial VA dissections treated between 1995 and 2007.
- Focus on 14 cases associated with aneurysms requiring surgical intervention.
- Categorization into hemorrhagic and non-hemorrhagic groups for outcome comparison.
Main Results:
- In the hemorrhagic group (5 cases), 2 achieved good recovery (GR), while 3 had severe disability despite treatments like internal trapping of aneurysm (ITA).
- In the non-hemorrhagic group (9 cases), all patients achieved good recovery (GR) with various surgical techniques including ITA and bypass surgery.
- Treatment-related complications were noted in both groups, but outcomes were significantly better in the non-hemorrhagic cohort.
Conclusions:
- Hemorrhagic intracranial VA dissections carry a more severe prognosis than non-hemorrhagic ones.
- Surgical treatment strategies must be individualized based on aneurysm location and the origin of the posterior inferior cerebellar artery (PICA).
Object:
Intracranial VA dissections are reported to cause headache, brain stem infarction, and SAH with an associated high morbidity and mortality. We aimed to clarify both the clinical characteristics and effectual treatment of intracranial VA dissections, and to present a retrospective analysis of our experience in the treatment.
Material And Method:
Between 1995 and 2007 we experienced 62 VA dissections in our institution. Fourteen of 62 (23%) cases of VA dissections were associated with aneurysm, and received surgical treatment. Five of fourteen cases presented with SAH, 8/14 cases with ischemia, 1/14 cases with headache.
Results:
In the hemorrhagic group, internal trapping of aneurysm (ITA) was successfully performed in four cases. In one case, bypass surgery was followed by ITA, while one case with treatment-related complication was observed. But Glasgow Outcome Scale (GOS) of almost all cases was severe; 2/5 cases showed good recovery (GR), and 3/5 cases had severe disability. In the non-hemorrhagic group, proximal clipping or trapping was performed in 4/9 cases. Bypass surgery followed by proximal clipping or trapping was performed in 2/9 cases, and ITA in 1/9 case. One case showed treatment-related complication. GOS was GR in all cases.
Conclusion:
Outcome in the hemorrhagic group was more severe as compared to the non-hemorrhagic group. The surgical strategy should be planned according to the location of the aneurysm and the origin of PICA.
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