title: Internal trapping following proximal clipping for a ruptured partially thrombosed giant aneurysm of the vertebral artery--case report.
abstract: A 52-year-old woman presented with a partially thrombosed giant aneurysm of the vertebral artery (VA) manifesting as a 3-month history of left hemiparesis. She developed subarachnoid hemorrhage during hospitalization and underwent emergency surgery for surgical proximal clipping and ventricular drainage with decompressive suboccipital craniectomy. She underwent additional surgery for endovascular coil embolization of the aneurysm and the affected distal VA on the 7th postoperative day. Although she suffered transient lower cranial nerve pareses and respiratory failure, her neurological condition improved gradually and she returned home with only slight ataxia and hoarseness 3 months after surgery. Magnetic resonance imaging obtained 28 months postoperatively revealed a remarkable decrease in the size of the aneurysm as well as reduction of the mass effect on the brainstem. Combined proximal clipping and internal trapping can solve the problems associated with treatment of giant aneurysms of VA by either direct surgery or endovascular surgery, and should be considered as a therapeutic option for giant aneurysms of the VA.
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Terakawa
authors.forename: Akinori
authors.initials: A
authors.lastname: Yamamura
authors.forename: Naoaki
authors.initials: N
authors.lastname: Murayama
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kimura
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Masahito
authors.initials: M
authors.lastname: Fujishige
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Nunomura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ogawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hashi
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D003389:Cranial Nerve Diseases / Q000209:etiology; D003399:Craniotomy; D004322:Drainage; D004621:Embolization, Therapeutic; D004630:Emergencies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D012086:Reoperation; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*