title: [Therapeutic occlusion of unilateral vertebral artery for unclippable aneurysms; special reference to postoperative brainstem ischemia].
abstract: 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.
authors.affiliation: Department of Neurosurgery, Baba Memorial Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Yasui
authors.forename: H
authors.initials: H
authors.lastname: Yagura
authors.forename: M
authors.initials: M
authors.lastname: Komiyama
authors.forename: Y
authors.initials: Y
authors.lastname: Fu
authors.forename: Y
authors.initials: Y
authors.lastname: Nagata
authors.forename: K
authors.initials: K
authors.lastname: Tamura
authors.forename: A
authors.initials: A
authors.lastname: Kim
mesh_terms: 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