[Dissecting aneurysm of the vertebral artery--report of two cases and review of the literature].
Two cases of dissecting aneurysm of the vertebral artery are reported and the 70 cases reported previously are reviewed. Case 1 showed Wallenberg's syndrome following sudden headache on the right side without SAH. Angiograms demonstrated the "pearl and string sign" on the right vertebral artery, characteristic of a dissecting aneurysm. Through a right suboccipital craniectomy, the right vertebral artery was found to be discolored purplish-red and swollen, so the proximal vertebral artery was clipped. The postoperative course was uneventful. Case 2 showed Wallenberg's syndrome with antecedent headache. CT scan was normal and lumber puncture revealed xanthochromic CSF, which was attributed to a SAH several days before. Angiograms disclosed the "pearl and string sign" on the right vertebral artery, and right vertebral artery clipping was performed. Postoperatively it was uneventful. Intracranial dissecting aneurysms of the vertebrobasilar system are not as rare as previously thought. They can often be overlooked as fusiform aneurysms or as thrombosis associated with SAH and/or ischemic attacks. The difficulty in diagnosis, leads to a high morbidity and mortality rate. Recently many cases have been reported in sequence. These cases involving SAH were successfully treated by surgical procedure. However in addition to our cases, only two cases of successful surgical treatment after ischemic stroke, have been reported. We emphasize that surgical intervention should be carried out for dissecting aneurysms of the vertebro-basilar system, even without SAH, to prevent further dissection which could cause SAH or/and further brainstem infarction. Proximal vertebral artery occlusion is the most beneficial treatment of choice.(ABSTRACT TRUNCATED AT 250 WORDS)
Tanabe
H
H
Division of Neurosurgery, Shiroyama Hospital.
Manno
T
T
Tanobe
Y
Y
Aoyagi
M
M
Shiguma
M
M
Ohta
T
T
D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery