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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Management strategy for bilateral complex vertebral artery aneurysms.

Norihiro Saito1,2, Hiroyasu Kamiyama3, Katsumi Takizawa4

  • 1Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan. norihirosai@pro.odn.ne.jp.

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|November 14, 2015
PubMed
Summary

Managing bilateral complex vertebral artery aneurysms (BCoVAAns) is challenging. A combined revascularization strategy, preserving vertebral artery (VA) flow, allows safe treatment of both aneurysms, preventing regrowth and bleeding.

Keywords:
Bilateral vertebral arteriesComplex aneurysmGrowingRevascularization

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Area of Science:

  • Neurosurgery
  • Vascular Surgery
  • Interventional Neurology

Background:

  • Bilateral complex vertebral artery aneurysms (BCoVAAns) lack a defined management protocol.
  • Unilateral treatment carries risks of contralateral lesion growth and lower cranial nerve (LCN) injury.

Purpose of the Study:

  • To propose and evaluate a management strategy for unruptured BCoVAAns.
  • To assess the safety and efficacy of combined open and interventional treatment with revascularization.

Main Methods:

  • Retrospective review of five patients with unruptured BCoVAAns (Jan 2006-Dec 2012).
  • Utilized techniques including bypass grafts (OA-PICA, STA-SCA, V3-V4 RA), parent artery occlusion with monitoring (Distal BP, MEPs, SEPs), and VA fenestration.
  • Two patients treated bilaterally, three unilaterally.

Main Results:

  • Modified Rankin Scale (mRS) at 39 months: 0 (2 patients), 1 (2 patients), 2 (1 patient).
  • No regrowth or bleeding observed in untreated contralateral lesions.
  • Complications included dysphagia (LCN palsies) in two patients with V3-RA-V4 bypass and cerebellar infarction in one patient due to bypass occlusion.

Conclusions:

  • Revascularization or vertebral artery (VA) preservation is crucial for initial surgical management of BCoVAAns.
  • This approach facilitates effective contralateral aneurysm occlusion (e.g., coil embolization), even with VA sacrifice.
  • The proposed strategy effectively manages BCoVAAns while mitigating risks associated with unilateral treatment.