Abstract
Dissecting intracranial aneurysms are treated most commonly by proximal ligation of the vertebral artery or trapping. We have, however, treated such patients by reconstruction of the vertebral arteries with fenestrated clips. Patients with vertebral artery dissecting aneurysms were classified into 2 groups based on the results of angiogram. The first group consisted of patients in whom the dissection was confirmed on unilateral side of the artery (one-side type). In the second group, the dissection involved the entire circumference of the artery (whole-around type). From April 1973 to July 1994, 1402 patients with intracranial aneurysms, including 45 vertebral artery aneurysms, underwent operation. Of the 45 patients with vertebral artery aneurysms, 16 had dissecting aneurysms.
They were divided equally between one-side type and whole-around type. Six patients of one-side type underwent clipping and vertebral artery reconstruction. There was 1 unsuccessful outcome. This patient was elderly and was treated prior to the development of fenestrated clips. Of the whole-around type, 2 patients exhibited clinical deterioration on the second day following trapping due to retrograde thrombosis. Two other patients had follow-up angiograms that revealed enlargement of the aneurysm. Daughter clipping and wrapping were performed. There were 3 deaths in patients for whom surgery was contraindicated because poor neurological findings.
Arterial reconstruction should be considered in patients with dissecting intracranial vertebral artery aneurysms confined to one side of the artery. Proximal clipping or trapping should be employed in patients in whom 3 dissections involve the whole circumference of the artery.
