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Diagnosis and treatment of vertebral aneurysms
1Department of Neurological Surgery, Chiba University School of Medicine, Japan.
Insights
Posterior fossa aneurysms, including saccular, dissecting, and fusiform types, were studied. Dissecting aneurysms frequently bled and rebled, unlike benign fusiform types, indicating different management needs.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Intracranial vertebral artery aneurysms are common in the posterior fossa.
- Aneurysms in this region present diverse clinical manifestations, diagnostic challenges, and treatment considerations.
Purpose of the Study:
- To analyze the clinical presentation, diagnosis, and treatment of intracranial vertebral artery aneurysms.
- To differentiate between saccular, dissecting, and atherosclerotic fusiform aneurysms based on clinical and angiographic findings.
- To evaluate the outcomes associated with different aneurysm types.
Main Methods:
- Retrospective analysis of 94 aneurysms in 86 patients.
- Classification of aneurysms into saccular, dissecting, and atherosclerotic fusiform types.
- Review of clinical data, diagnostic imaging (angiography), and treatment outcomes.
Main Results:
- Saccular aneurysms (60%) were most common, followed by dissecting (28%) and atherosclerotic fusiform (13%).
- Dissecting aneurysms had high rates of bleeding (81%) and rebleeding (24%), and were associated with poor outcomes and lateral medullary syndrome.
- Atherosclerotic fusiform aneurysms did not bleed; differentiation from dissecting aneurysms was challenging angiographically.
- Small atherosclerotic fusiform aneurysms appeared benign and required no surgical intervention.
Conclusions:
- Intracranial vertebral artery aneurysms exhibit distinct subtypes with varying clinical behaviors and prognoses.
- Dissecting aneurysms represent a high-risk subgroup requiring aggressive management.
- Small atherosclerotic fusiform aneurysms may be managed conservatively.
Abstract:
The intracranial vertebral artery and its branches are a common site of aneurysms in the posterior fossa. Ninety-four aneurysms in 86 patients were analyzed for their clinical manifestation, diagnosis, and treatment. There were three distinct varieties of aneurysm in this group: 56 (60%) saccular aneurysms, 26 (28%) dissecting aneurysms, and 12 (13%) atherosclerotic fusiform aneurysms. Of the 26 dissecting aneurysms, 81% bled and 24% of these rebled. None of the atherosclerotic fusiform aneurysms bled. Angiographic differentiation between dissecting aneurysms and atherosclerotic fusiform aneurysms was difficult. The dissecting aneurysms were characterized by a "narrowed segment" proximal and/or distal to a "fusiform dilatation" of the affected artery and by the presence of contrast medium in the intramural false lumen until the late phase. Poor postoperative outcome and the lateral medullary syndrome were seen only in dissecting aneurysms. Small atherosclerotic fusiform aneurysms seemed to be benign lesions that do not require any surgical treatment.