title: Spontaneous dissecting aneurysm of the intracranial vertebral artery: management strategies.
abstract: OBJECTIVE
  Pathogenesis and treatment of spontaneous dissecting aneurysm of the intracranial vertebral artery (VA) remain controversial. This study was designed to provide management strategies and to improve management outcome in patients with these aneurysms.
  
  
  METHODS
  Among a total of 1,990 patients treated for intracranial aneurysms from February 1992 to June 2005, 28 patients (1.4%) were treated either by surgery (8 patients) or neurointervention (20 patients) for spontaneous dissecting aneurysms of the intracranial VA. Twenty-two patients had ruptured aneurysms. We analyzed indications of surgery or neurointervention for each case, and assessed the management outcome at a 6-month follow-up.
  
  
  RESULTS
  For selection of therapeutic options, patients were initially evaluated as possible candidates for neurointervention using the following criteria: 1) poor clinical grade; 2) advanced age; 3) medical illness; 4) unruptured aneurysm; 5) equal or larger opposite VA; 6) anticipated surgical difficulty due to a deep location of the VA-posterior inferior cerebellar artery (PICA) junction. Surgery was considered for patients with: 1) high-risk aneurysms (large or irregular shaped); 2) smaller opposite VA; 3) failed neurointervention; or 4) dissection involving the PICA. Management outcomes were favorable in 25 patients (89.3%). Causes of unfavorable outcome in the remaining 3 patients were the initial insult in 2 patients, and medical complications in one patient.
  
  
  CONCLUSIONS
  Ruptured aneurysms must be treated to prevent rebleeding. For unruptured aneurysms, follow-up angiography would be necessary to detect growth of the aneurysm. Treatment modality should be selected according to the clinical characteristics of each patient and close collaboration between neurosurgeons and neurointerventionists is essential.
authors.affiliation: Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120- 752, Korea.
authors.forename: Jae Whan
authors.initials: JW
authors.lastname: Lee
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Jung
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
authors.forename: Seung Kon
authors.initials: SK
authors.lastname: Huh
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
authors.forename: Kyu Chang
authors.initials: KC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000473:pathology / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000473:pathology* / Q000601:surgery