抄録
The natural history of intracranial dissecting aneurysms is not precisely known. Therefore, it is difficult to decide how to manage this disease. This study focused on the analysis of patients with unruptured intracranial dissecting aneurysm of the vertebrobasilar (V-B) system.
The serial angiographic findings and the long-term outcome of 12 consecutive patients presenting with ischemia/infarction and/or headache were analyzed. Two patients had multiple dissecting aneurysms. Three patients were treated surgically and the other 9 were treated conservatively (rigorous control of blood pressure/no anticoagulants). The mean follow-up period was 4.2 years.
Males were predominant (10:2) and the mean age was 42.6 years in the 12 patients. Ten arterial dissections occurred in the vertebral artery (2 extended to the basilar artery), 3 in the posterior inferior cerebellar artery and 1 in the posterior cerebral artery. Pearl and string sign was the most common finding and fusiform dilatation and retention of the contrast media in the venous phase were also frequently observed on the initial angiography. On the serial angiography, improvement or normalization of the arterial configuration was observed in 4 of 6 arterial dissections (67%). In 1 patient, enlarged arterial dissection was observed on the serial angiography and was treated by intravascular surgery, using the detachable balloon. Long-term follow-up was available in 11 patients (two treated surgically and 9 conservatively). Ten of the 11 patients (91%) achieved good recovery and returned to work. One patient, who had a second attack of ischemia and was admitted in semicoma, became severely disabled ultimately on 9-years follow-up. No more recurrence of ischemia or associated subarachnoid hemorrhage occurred in any of the 11 patients.
These results suggested that unruptured intracranial dissecting aneurysms of the V-B system were mostly correlated with a benign clinical course, and could be treated conservatively. It is stressed that surgical intervention, including intravascular surgery, should be considered when enlarged dissection has been observed on the serial angiography.
