2020 Volume 25 Issue 2 Pages 259-267
The recurrent bleeding rate and mortality rate of ruptured vertebral artery dissecting aneurysms are high. We investigated the surgical outcomes of ruptured vertebral artery dissecting aneurysms treated by direct surgery or endovascular treatment during the period April 2004 to September 2019. In our hospital, craniotomy was the first choice for treatment during the years 2004‒2016, and endovascular treatment has been the first choice since April 2016. In 2004‒2016, direct surgery was performed in eight patients. From April 2016, endovascular treatment was performed in four patients. Almost all patients showed a poor preoperative World Federation of Neurosurgical Societies (WFNS) grade, which made it difficult to compare the patients in prophase and in anaphase. In the anaphase group, we performed proximal occlusion as endovascular treatment for one patient (posterior inferior cerebellar artery [PICA] involved type) and internal trapping for three patients (PICA distal type). One patient experienced a lateral medullary infarction, but there has been no case of recurrent bleeding. We speculate that proximal occlusion as an endovascular treatment for PICA involved ruptured vertebral artery dissecting aneurysms is useful for preventing ischemic complications and re‒rupture.
