Two Cases of Ruptured Dissecting Aneurysms presenting with Subarachnoid Hemorrhage and treated Successfully by Surgical Craniotomy

Abstract

  We report two cases of ruptured dissecting cerebral aneurysms presenting with subarachnoid hemorrhage (SAH) that were successfully treated with surgical craniotomy. In case 1, there was a ruptured dissecting aneurysm in the A1 portion of the anterior cerebral artery. Although the cause of the hemorrhage could not be confirmed by preoperative imaging examination, the rupture point was confirmed under direct vision, and the parent artery was trapped after preserving the perforating artery. In case 2, there was a ruptured dissecting aneurysm in the V4 portion of the vertebral artery (VA). The VA of the contralateral side was of the posterior inferior cerebellar artery end type ; therefore, we performed angioplastic partial clipping of the rupture point while preserving the blood flow in the parent artery. By performing direct surgery, we were able to preserve the blood flow in the perforating artery and the parent artery, as well as confirm the rupture point, which is considered difficult in endovascular treatment.