Abstract
We have reviewed initial diagnostic features, treatment, and outcome in 29 patients with acute subarachnoid hemorrhage due to non-traumatic vertebrobasilar artery dissection diagnosed in our hospital between 1993 and 2003. The dissections occurred in the vertebral artery in 19 patients, the posterior inferior cerebellar artery (PICA) in two patients, the basilar artery in four patients, and in the vertebral artery extending into the PICA in four patients. A pseudoaneurysm was found in 20 patients. Clinical manifestations typically included sudden onset of moderate to severe headache, nuchal rigidity, and drowsiness. Fourteen patients were treated conservatively. Fifteen patients underwent endovascular treatment with either parent artery occlusion (13 patients) or aneurysmal coil occlusion with preservation of the parent artery (2 patients). Re-bleeding occurred within 12 days and before treatment in nine patients. Eight of these had a pseudoaneurysm. No patient bled after endovascular treatment. Poor grade and early re-bleeding were associated with less favorable outcome. Outcome at 6 months did not differ significantly between endovascular and conservative treatment. Altogether, good recovery was achieved for 16 patients, moderate disability was seen in one, severe disability in four, and eight patients (27%) died. The absence of bleeding subsequent to endovascular treatment in this study suggests that endovascular treatment may be a rational approach in these patients at high risk of re-bleeding, especially those with a pseudoaneurysm.
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Sasaki O, Ogawa H, Koike T, Koizumi T, Tanaka R (1991) A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:874–882
Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188
Berger MS, Wilson CB (1984) Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894
Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–911
Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM (2003) Endovascular management of vertebrobasilar dissecting aneurysms. Am J Neuroradiol 24: 1421–1428
Anxionnat R, Ferreiera de Melo Neto J, Bracard S, Lacour JC, Pinelli C, Civit T, Picard L (2003) Treatment of hemorrhagic intracranial dissections. Neurosurgery 53:289–300
Kai Y, Hamada IJ, Morioka M, Todaka T, Mizuno T, Ushio Y (2003) Endovascular coil trapping for ruptured vertebral artery dissecting aneurysms by use of double microcatheters technique in the acute stage. Acta Neurochir 145:447–451
Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, Takahashi JC, Nagata I (2002) Dissecting aneurysms of the vertebral artery: a management strategy. Neurosurgery 97:259–267
Kurata A, Ohmomo T, Miyasaka Y, Fujii K, Kan S, Kitahara T (2001) Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22:11–18
Metha B, Burke T, Kole M, Bydon A, Seyfried D, Malik G (2003) Stent-with-a-stent technique for treatment of dissecting vertebral artery aneurysms. AJNR Am J Neuroradiol 24:1814–1818
Willing SJ, Skidmore F, Donaldson J, Lisandro Nobo U, Chernukha K (2003) Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement; report of two cases. AJNR Am J Neuroradiol 24:985–989
Yasui T, Komiyama M, Nishikawa M, Nakajima H (2000) Subarachnoid hemorrhage from vertebral dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature. Neurosurgery 46:196–200
Otawara Y, Ogasawara K, Ogawa A, Kogure T (2002) Dissecting aneurysms of the bilateral vertebral arteries with subarachnoid hemorrhage: report of three cases. Neurosurgery 50:1372–1374
Conforto AB, Yamamoto F, Evaristo EF, Puglia P Jr, Caldas JG, Scaff M (2001) Intracranial vertebral artery dissection presenting as subarachnoid hemorrhage: successful endovascular treatment. Acta Neurol Scand 103:64–68
Ali MJ, Bendok BR, Tawk RG, Getch CC, Batjer HH (2002) Trapping and revascularization for a dissecting aneurysm of the proximal posteroinferior cerebellar artery: technical case report and review of the literature. Neurosurgery 51:258–262
Benndorf G, Herbon U, Sollmann WP, Campi A (2001) Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 22:1844–1848
Yamaura I, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, Matsumoto T (1999) Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90:853–856
Friedman AH, Drake CG (1984) Subarachnoid hemorrhage from intracranial dissecting aneurysms. J Neurosurg 60:325–334
Halbach VV, Higashida RT, Dowd CF, Fraser KW, Smith TP, Teitelbaum GP, Wilson CB, Hieshima GB (1993) Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:183–191
Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2001) Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94:427–432
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20
Shin JH, Suh DC, Choi CG, Leei HK (2000) Vertebral artery dissection: spectrum of imaging findings with emphasis on angiography and correlation with clinical presentation. Radiographics 20:1687–1696
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484
Hart RG, Easton JD (1983) Dissections of cervical and cerebral arteries. Neurol Clin 1:155–182
Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631
Tsukahara T, Wada H, Satake K, Yaoita H, Takahashi A (1995) Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage. Neurosurgery 36:914–919
Redekop G, TerBrugge K, Willinsky R (1999) Subarachnoid hemorrhage from vertebrobasilar dissecting aneurysm treated with staged bilateral vertebral artery occlusion: the importance of early follow-up angiography: technical case report. Neurosurgery 45:1258–1262
Manabe H, Hatayama T, Hasegawa S, Islam SM, Suzuki S (2000) Coil embolisation for ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery. Neuroradiology 42:384–387
Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) The “Remodelling technique” in the treatment of wide neck intracranial aneurysms. Interv Neuroradiol 3:21–35
Phan T, Huston J III, Bernstein MA, Riederer SJ, Brown RD Jr (2001) Contrast-enhanced magnetic resonance angiography of the cervical vessels: experience with 422 patients. Stroke 32:2282–2286
Sanelli PC, Tong S, Gonzalez RG, Eskey CJ (2002) Normal variation of vertebral artery on CT angiography and its implications for diagnosis of acquired pathology. J Comput Assist Tomogr 26:462–470
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Ramgren, B., Cronqvist, M., Romner, B. et al. Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients. Neuroradiology 47, 97–104 (2005). https://doi.org/10.1007/s00234-005-1346-z
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DOI: https://doi.org/10.1007/s00234-005-1346-z