Treatment strategy for vertebral artery dissecting aneurysm (VADA) remains controversial even though satisfactory results have been reported with proximal clipping (PrC) and trapping. We report 9 cases of VADA and reviewed the literatures with special reference to time and rate of rebleeding, timing of surgery, result and risk of acute staged surgery and the natural history. Rebleeding occurred in 50.0% of our cases and in 21.4-79.4% of the reported ones. Twenty-five of 78 cases, which included reported cases and ours, rebled on day zero. Acute staged surgeries were performed in 21 cases, with satisfactory results. We also discuss the risk of PrC. Natural healing has been reported in only 3 cases presented with subarachnoid hemorrhage. We therefore recommend the following strategy for treating VADA: 1) Acute staged surgery should be done primarily. 2) Proximal clipping should be the first procedure. 3) According to the intraoperative findings of the Doppler sonography and change in the aneurysm size after proximal clipping, the operating method should be changed to trapping. 4) Postoperative angiography should be done within a few days after the proximal clipping.
