title: Dissecting aneurysms of the bilateral vertebral arteries with subarachnoid hemorrhage: report of three cases.
abstract: OBJECTIVE
  Treatment of one side in cases of dissecting aneurysms of the bilateral vertebral arteries (VAs) with subarachnoid hemorrhage may result in dissection or rupture on the contralateral side.
  
  
  METHODS
  Three patients presented with dissecting aneurysms of the bilateral VAs with subarachnoid hemorrhage.
  
  
  METHODS
  Two patients underwent trapping of the ruptured VA, with side-to-side anastomosis between the bilateral posteroinferior cerebellar arteries. One patient underwent resection of the ruptured VA, with interposition of a saphenous vein graft. Two patients died as a result of rupture of the contralateral VA dissecting aneurysm after surgery. One patient demonstrated development of an unruptured dissecting aneurysm in the contralateral VA 1 month after surgery.
  
  
  CONCLUSIONS
  Surgical intervention to treat dissecting aneurysms of the bilateral VAs on one side carries the risk of rupture of the contralateral lesion. Increased hemodynamic stress may be important in the development and rupture of dissections in the contralateral VA.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Uchimaru, Morioka, Japan. ootawara-nsu@umin.ac.jp
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Otawara
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kogure
mesh_terms: D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D012008:Recurrence; D012501:Saphenous Vein / Q000637:transplantation; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014711:Vertebral Artery / Q000000981:diagnostic imaging