Article
Single-center experience of treatments for ruptured intracranial vertebral artery dissecting aneurysms
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Authors
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Insung Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital
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Kwangho Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital
| Published: | June 8, 2016 |
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Outline
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Objective: Intracranial vertebral artery dissecting aneurysms are rare lesion and considered as important cause of spontaneous subarachnoid hemorrhage. Ruptured intracranial vertebral artery dissecting aneurysms are associated with high risk of rebleeding and high mortality. We report experience of treatments for ruptured intracranial vertebral artery dissecting aneurysms during 10 years.
Method: In the retrospective single center study, a total Twenty-one consecutive patients were included between February 2005 and March 2015. Five patients were excluded by follow-up loss and insufficiency of clinical data in this study. There were 6 men and ten women, ranging in age from 34 to 73 years (mean age 51.93 years). Clinical features, radiologic finding at initial examination, modality of treatment, functional outcome at last follow-up, mortality and radiologic outcome at more 6 months later after initial treatment were evaluated.
Results: A total sixteen patients were included. The aneurysms were located proximal to the posterior inferior cerebellar artery (PICA) in 1, distal to the PICA in 8, involved the PICA in 6 and involved anterior spinal artery in 1. Rebleeding rate was 18% during preoperative period. All sixteen aneurysms were treated endovascular, tapping in 9 patients and vascular reconstruction in 7 patients. In 6 aneurysms involved the PICA, modalities of treatment were trapping in 3 patients and vascular reconstruction in 3 patients. The duration of mean follow-up was 29 months (range 6-70 months). Five patients were expired and mortality rate was 31%. Unfavorable outcome rate(modified Rankin Scale>2) except for expired patients were 36%. Overall mean mRS for survivors was about 1.8. Angiographic follow-up for survivors (n=11, mean 13 months, range 6-46 months) showed recanalization in only 1 aneurysm.
Conclusions: Ruptured vertebral artery dissecting aneurysms is associated with poor functional outcome and high mortality. It is necessary to more immediate treatments due to highly rebleeding rate. Additionally, endovascular treatment may be a useful options of ruptured vertebral artery dissecting aneurysms.
