[Therapeutic occlusion of unilateral vertebral artery for unclippable aneurysms; special reference to postoperative brainstem ischemia].
Seven cases of unclippable vertebral artery aneurysms (3 dissecting, 1 fusiform, 2 saccular and 1 giant) are reported. Five of these had subarachnoid hemorrhage, one showed mass effect and the other was found incidentally. Trapping of the involved portion of the vertebral artery was performed in 4 cases, proximal clip occlusion in 2 and proximal balloon occlusion in 1. There were no operative deaths and no rebleeding, but brainstem ischemia developed in 4 cases, two being transient and two permanent. The ischemic complications were possibly due to; (a) hypoperfusion in the transient cases and (b) thromboenbolism, from the partially thrombosed giant aneurysm or thrombosis of the cul-de-sac vertebral artery, in the permanent ones. Preoperative temporary vertebral artery occlusion with an inflatable balloon or postoperative anticoagulant therapy should be considered in the management protocol.
Yasui
T
T
Department of Neurosurgery, Baba Memorial Hospital.
Yagura
H
H
Komiyama
M
M
Fu
Y
Y
Nagata
Y
Y
Tamura
K
K
Kim
A
A
D000784:Aortic Dissection / Q000150:complications / Q000601:surgery; D002545:Brain Ischemia / Q000209:etiology*; D001933:Brain Stem / Q000098:blood supply*; D003250:Constriction; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D002542:Intracranial Embolism and Thrombosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014711:Vertebral Artery