抄録
The authors present 33 patients with dissecting aneurysm of the intracranial vertebral artery, of whom subarachnoid hemorrhage developed in 26 patients and cerebral ischemia in 7 patients. Sixteen patients were surgically treated and 17 were conservatively treated. In this series, recurrent hemorrhage occured in 9 (35%) of 26 patients who presented with subarachnoid hemorrhage within 2 weeks after the initial ictus. The outcome of the cases with recurrent hemorrhage was very poor-7 of these 9 patients died. Therefore, surgical intervention during the acute stage is required to avoid the early rerupture. Comparative study with surgical and conservative treatment for dissecting aneurysms of the vertebral artery indicated that the outcome of patients with surgical treatment was much better than with conservative treatment. In surgical procedures, proximal clip-occlusion of the vertebral artery at the site distal to the PICA (DTP) was performed in 5 cases, at proximal to the PICA (PTP) in 4, trapping of the vertebral artery with dissecting aneurysm in 2, coating in 3, and proximal occlusion of the vertebral artery with detachable balloon in 2 patients. Postoperatively, transient lower cranial nerve palsy or cerebellar signs developed in 2 cases with trapping, in 1 with PTP and permanent hemiparesis due to thromboembolism at the top of the basilar artery in 1 with balloon-occlusion of the vertebral artery. In spite of surgical intervention, rerupture occured postoperatively in 1 case with coating and in 1 with DTP. Trapping procedure is most reliable to prevent rerupture of dissecting aneurysm, but it is difficult to expose the distal part of the vertebral artery beyond the aneurysm for trapping. Although proximal clip-occlusion is not completely satisfactory for prevention of rebleeding, it is simple as a method and useful for dissecting aneurysm of the vertebral artery.
