Abstract
Recently there have been reports of intracranial dissecting aneurysms. Most authors recommended proximal ligation of the vertebral artery or trapping as the modality of treatment.However, we have had cases in which reconstruction of vertebral arteries with fenestrated clips were performed. Vertebral artery dissecting aneurysms were classified into two groups based on angiograms. One group is the one-side type, which indicates that dissection occurred on one side, and the other is the whole-around type, which points to the progression of the dissection as a whole around the artery. From April 1973 to March 1993 we operated on 1,304 cases of intracranial aneurysms, including 41 vertebral aneurysms. Eleven of the latter were suspected to have dissecting aneurysms based on angiograms and surgery. Six out of 7 cases had one-side type dissecting aneurysms, which were clipped directly and the vertebral arteries were reconstructed. One unsuccessful case had been an aged patient when surgery was done prior to the development of fenestrated clips. Two out of 4 cases had whole-around type aneurysms and underwent proximal clipping and trapping. One case became worse after the second day of trapping because of retrograde thrombosis. Two patients, for whom surgery was contraindicated because of bad neurological condition, died.
