title: Surgical treatment of intracranial VA dissecting aneurysm.
abstract: OBJECTIVE
  Intracranial VA dissections are reported to cause headache, brain stem infarction, and SAH with an associated high morbidity and mortality. We aimed to clarify both the clinical characteristics and effectual treatment of intracranial VA dissections, and to present a retrospective analysis of our experience in the treatment.
  
  
  METHODS
  Between 1995 and 2007 we experienced 62 VA dissections in our institution. Fourteen of 62 (23%) cases of VA dissections were associated with aneurysm, and received surgical treatment. Five of fourteen cases presented with SAH, 8/14 cases with ischemia, 1/14 cases with headache.
  
  
  RESULTS
  In the hemorrhagic group, internal trapping of aneurysm (ITA) was successfully performed in four cases. In one case, bypass surgery was followed by ITA, while one case with treatment-related complication was observed. But Glasgow Outcome Scale (GOS) of almost all cases was severe; 2/5 cases showed good recovery (GR), and 3/5 cases had severe disability. In the non-hemorrhagic group, proximal clipping or trapping was performed in 4/9 cases. Bypass surgery followed by proximal clipping or trapping was performed in 2/9 cases, and ITA in 1/9 case. One case showed treatment-related complication. GOS was GR in all cases.
  
  
  CONCLUSIONS
  Outcome in the hemorrhagic group was more severe as compared to the non-hemorrhagic group. The surgical strategy should be planned according to the location of the aneurysm and the origin of PICA.
authors: Department of Neurosurgery, Fukuoka University School of medicine, 7-45-1 Nanakuma, Jounan-ku, Fukuoka-shi, Fukuoka, 814-0180, Japan. take9016@fukuoka-.ac.jp
authors: Koichiro
authors: K
authors: Takemoto
authors: Hiroshi
authors: H
authors: Abe
authors: Ken
authors: K
authors: Uda
authors: Tooru
authors: T
authors: Inoue
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000601:surgery*