[Surgical treatment of ruptured dissecting aneurysms: proximal clipping vs trapping]

The best surgical treatment for ruptured dissecting aneurysms of the vertebral artery is still controversial. Four patients (1 male, 3 female), age ranging from 43 to 62, were operated upon in our department during the last 6 years. Duration from rupture to the operation was 0 to 4 days. In 2 cases, proximal clipping was the primary treatment, while 2 had a trapping. Antiplatelet agents were given to prevent vasospasm in all cases postoperatively. In proximal clipping cases, one patient had suffered from fatal rerupture on the sixth postoperative day. In trapping cases, Wallenberg syndrome developed in one patient. These results suggest that a proximal clipping may not allow the treatment for the vasospasm because of the danger of rebleeding and also a trapped segment of vertebral artery should be as short as possible to avoid compromised perforators.