title: State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms.
abstract: Vertebrobasilar (VB) intracranial dissecting aneurysms (IDAs) pose difficult therapeutic issues and are especially among the most difficult to manage surgically. There are, however, some cases where selective aneurysm obliteration by endovascular approach is impossible or is associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is dissecting, giant, or has a large neck. In such cases, surgical treatment may be the only alternative. Optimal management of these lesions is therefore challenging and treatment decisions have to be made on a case-by-case basis. Ideal treatment should be a complete surgical excision of the lesion; however, this procedure might only be possible after distal and proximal vessel wall occlusion which might not be tolerated by the patient depending on the location of the aneurysm. Therefore, formulation of recommendations concerning the surgical strategy remains still difficult due to inconsistency of surgical outcomes. The literature describing surgical strategy of VB IDAs is varying in quality and content, and many studies deal with only a few patients. In the presented review, the authors summarize the current knowledge on the incidence, pathogenesis, clinical presentation, and diagnostic procedures with special emphasis on surgical treatment of IDAs in posterior circulation.
authors.affiliation: Department of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic. balik.vladimir@gmail.com.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Balik
authors.affiliation: Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Neurosurgery, Andhra Medical College, Maharanipeta, Visakhapatnam, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Talari
authors.affiliation: Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
authors.forename: Yamashiro
authors.initials: Y
authors.lastname: Kei
authors.affiliation: Department of Neurosurgery, Sogo Shinkawabashi Hospital, Kawasaki-city, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Sano
authors.affiliation: Department of Neurosurgery, Fuchu Keijinkai Hospital, Fuchu city, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suyama
authors.affiliation: Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
authors.forename: Tukasa
authors.initials: T
authors.lastname: Kawase
authors.affiliation: Normal Pressure Hydrocephalus Center, Chiba Kashiwa Tanaka Hospital, Kashiwa city, Chiba, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Takizawa
authors.affiliation: Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000209:etiology / Q000601:surgery
keywords: Intracranial dissecting aneurysm; Posterior circulation; Surgical treatment