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Staged, Combined Management of Ruptured Vertebral Artery Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery: Report of 4 Cases and Review of the Literature
- Source :
- World neurosurgery. 128
- Publication Year :
- 2019
-
Abstract
- Background Ruptured vertebral artery dissecting aneurysms (VADAs) involving the posterior inferior cerebellar artery (PICA) are the most difficult to treat among variations of VADAs but require prompt treatment. The major challenge is to preserve the PICA while occluding the aneurysm. Despite advances in the management of ruptured VADAs involving the PICA, each treatment, whether it is combined or not, is associated with a significant degree of risk. Case Description This study presents 4 cases of ruptured VADAs involving the PICA that were successfully treated using a staged, combined method. Embolization of the rupture point in the acute stage was followed 3–4 weeks later by occlusion of the proximal vertebral artery (VA) and PICA origin after occipital artery–PICA bypass in the chronic stage. Conclusions Although it is sometimes very difficult to determine the exact rupture point of VADAs, ruptures tend to occur at distal segments of a dissecting aneurysm presenting as bleb. Also, when planning a trapping of the VA, careful examination of angiography is needed to assess the contralateral VA and rupture point. Our staged and combined strategy may provide another valuable treatment option for treating VADAs involving the PICA with special emphasis on the safety and efficacy in our method.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Vertebral artery
Aneurysm, Ruptured
Neurosurgical Procedures
03 medical and health sciences
0302 clinical medicine
Aneurysm
medicine.artery
Cerebellum
Occlusion
medicine
Humans
Embolization
Pica (disorder)
Vertebral Artery Dissection
medicine.diagnostic_test
business.industry
Endovascular Procedures
Middle Aged
medicine.disease
Embolization, Therapeutic
Surgery
Cerebral Angiography
Dissecting Aneurysms
Aortic Dissection
Posterior inferior cerebellar artery
030220 oncology & carcinogenesis
Angiography
Female
Vascular Grafting
Neurology (clinical)
medicine.symptom
business
Organ Sparing Treatments
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 128
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....23940c4ea9c353312bb89dd95fc3ba78