Surgery for vertebral dissecting aneurysm in the era of developing intravascular therapy

Abstract

Vertebral artery (VA) dissecting aneurysms presenting with subarachnoid hemorrhage (SAH) require prompt treatment, because they frequently rebleed within 24 hours. Recently, interventional radiology is prevailing in comparison with surgery. However, surgery is necessary for decompression or posterior inferior cerebellar artery (PICA)-involved vertebral artery dissecting aneurysm (VADA). Furthermore, infarction in the area of perforating artery is less frequent in surgery. One of the reasons of decrease of surgery is the blind inheritance of the conventional complex method with lateral position. On the other hand, surgery with prone position have a lot of advantages. The author details this method. The ideal direction of treatment of VADA is keeping a balance between developing intravesical recurrence (IVR) with surgery. For surgery, strategy and method must be rethought again.