Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature.
OBJECTIVE
To define the natural history of spontaneous intracranial vertebral artery dissections (VADs) and to review current treatment strategies.


METHODS
We searched the MEDLINE database for all existing English and French literature on VADs through January 2008. Keywords employed were intradural/intracranial vertebral artery dissection, vertebral artery dissection, and vertebral artery dissection treatment. We also reviewed our series of patients with spontaneous VAD treated in the past 5 years. Data were collected, categorized, and analyzed.


RESULTS
In our sample of 457 patients, men were more frequently affected than women, and the mean age was 51.8 years. The majority of patients (79%) presented with subarachnoid hemorrhage (SAH). We experienced a high incidence (37%) of recurrent SAH, particularly within the first 24 hours after SAH first occurred. Angiographic fusiform dilatation and pearl-and-string lesions were the most common finding. Patients who presented with SAH fared worse than those who presented with ischemia.


CONCLUSIONS
Due to a high rate of recurrent bleeding, we concluded that early treatment by either surgical or endovascular route is indicated in patients who present with SAH secondary to spontaneous intradural VADs. Treatment decisions should take into account the site and type of dissection, vertebral artery dominance, and involvement of posterior inferior cerebellar artery.
Kocaeli
Hasan
H
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Chaalala
Chiraz
C
Andaluz
Norberto
N
Zuccarello
Mario
M