The Surgical Treatment of Ruptured Vertebral Aneurysms : A Review of Forty Cases

Abstract

The authors have analyzed the overall surgical results of 40 ruptured vertebral artery (VA) aneurysm cases and discuss aspects of treatment. Depending on the type of aneurysm, these cases were classified into two groups : 1) a saccular aneurysm, and 2) a dissecting aneurysm. Twenty-seven cases consisted of saccular aneurysms [Hunt and Kosnik (H and K) Grade I: 10 cases. I a : 5, II: 2, III: 7, IV: 3], 25 of these cases being an aneurysm at the junction of VA and PICA, 1 an aneurysm at the distal portion of the PICA, and 1 an aneurysm at the VA trunk. Aneurysmal clipping was the surgical procedure for all cases, and in 7 cases the surgery was performed within 3 days after an SAH. The six month follow-up outcome was found to be excellent in 19 cases, good in 1 case, fair in 1 case, poor in 4 cases and 2 cases ended in death. The causes for unfavorable outcomes in 7 cases were primary brain damage in 2 cases, a vasospasm in 2 cases, and other medical complications in 3 cases. Thirteen cases consisted of dissecting aneurysms (H and K Grade I : 7, I a : 3, II: 2, III : 1). In 2 case surgery was performed within 3 days after an SAH. A total of 15 operations were performed for 13 cases (coating : 10, VA trapping : 2, clipping at the bleeding point : 2, VA proximal clipping : 1), and the outcome has been excellent in 9 cases, good in 2 cases, poor in I case and I case ended in death. The causes for unfavorable outcomes in 2 cases were a surgical procedure and a rebleeding. Based on these results, it can be concluded that early clipping is indicated for cases of a ruptured VA-PICA aneurysm, so as to prevent a delayed vasospasm and medical complications, and that VA trapping or careful coating can result in a favorable surgicai outcome for cases of a ruptured VA dissecting aneurysm.