title: Management strategy for bilateral complex vertebral artery aneurysms.
abstract: Bilateral complex vertebral artery aneurysms (BCoVAAns) have no established strategy of management. We retrospectively reviewed five consecutive patients with unruptured BCoVAAns between January 2006 and December 2012. Considering surgical risks of lower cranial nerve (LCN) injuries and eventual growth of an opposite side lesion after unilateral vertebral artery (VA) occlusion, we proposed a strategy of combined open and interventional treatment using revascularization. We applied the following several specific techniques: (1) proximal clipping and occipital artery-posterior inferior cerebellar artery (OA-PICA) and/or superficial temporary artery (STA)-superior cerebellar artery (SCA) bypasses; (2) Distal blood pressure, motor evoked potentials (MEPs), and somatosensory evoked potentials (SEPs) monitoring after parent artery temporary occlusion for safe permanent occlusion of the proximal portions of VA and PICA; (3) V3 to V4 bypass using radial artery (RA) graft with proximal clipping or trapping, two of them combined with OA-PICA bypass; (4) VA fenestration as an opportunity to preserve the flow of the parent artery. Two patients were treated bilaterally and 3 unilaterally, with modified Rankin scale assessed at 39 months postoperatively in average 0 in 2, 1 in 2, and 2 in 1, respectively, and the untreated opposite side lesions without regrowth or bleeding. Two patients with patent V3-RA-V4 bypass complained of dysphagia due to LCN palsies. One of them however suffered a cerebellar infarction due to occlusion of the OA-PICA bypass. When BCoVAAns require surgical treatment, revascularization or preservation of the VA should be considered at the first operation. By doing so, the opposite aneurysm can be effectively occluded by coil embolization, even with VA sacrifice if required.
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan. norihirosai@pro.odn.ne.jp.|Department of Neurosurgery, Sapporo Teishinkai Brain Institute, Sapporo, Hokkaido, Japan. norihirosai@pro.odn.ne.jp.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, Sapporo Teishinkai Brain Institute, Sapporo, Hokkaido, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Takizawa
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Takebayashi
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asano
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Kobayashi
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kubota
authors.affiliation: Department of Neurosurgery, Asahikawa Redcross Hospital Asahikawa, Asahikawa, Hokkaido, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Neurosurgery, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Kostadin L
authors.initials: KL
authors.lastname: Karagiozov
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000783:Aneurysm / Q000601:surgery*; D001488:Basilar Artery / Q000601:surgery; D002531:Cerebellum / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D014711:Vertebral Artery / Q000601:surgery*; D020217:Vertebral Artery Dissection / Q000601:surgery
keywords: Bilateral vertebral arteries; Complex aneurysm; Growing; Revascularization