Proximal ligation is generally accepted as the 1st choice of therapy for dissecting vertebral aneurysms. But recently, the problem of rerupture of aneurysm after proximal ligation has been reported. From this view-point, the trapping procedure may be the better choice for the treatment of ruptured dissecting vertebral aneurysms.
We have performed trapping procedures in 6 cases of ruptured dissecting vertebral aneurysms. The presigmoid approach was selected for 3 cases and lateral suboccipital approach for 3 cases. Based on these experiences, we would like to emphasize the advantages of the presigmoid approach. These advantages include on excellent view around the vertebro-basilar junction and less manipulation of the cerebellum and lower cranial nerves. A significant disadvantage of the presigmoid approach is hearing disturbance, which derives from possible intraoperative destruction of either the posterior semicircular canal or endolymphatic duct and sac. Tactics to avoid these complications is important for the better prognosis of these aneurysm patients.
We conclude that trapping might be the treatment of choice for patients of ruptured dissecting vertebral aneurysm, and selection of the surgical approach, presigmoid approach or lateral suboccipital approach, must be chosen by such criteria as location of the aneurysm and angiographic findings including hemodynamic consideration.
