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JOURNAL OF NEUROSURGICAL SCIENCES
Rivista di Neurochirurgia
Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
Journal of Neurosurgical Sciences 2016 Apr 28
Surgical treatment of unruptured dissecting intracranial aneurysms of vertebral posterior inferior cerebellar artery region and review of the literature
Vladimir BALIK 1, Yasuhiro YAMADA 2, Sandeep TALARI 3, Kei YAMASHIRO 2, Wu RILE 4, Daisuke SUYAMA 5, Tsukasa KAWASE 2, Kiyoshi TAKAGI 6, Katsumi TAKIZAWA 7, Yoko KATO 2 ✉
1 Department of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic; 2 Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Otobashi, Nakagawa-Ward, Nagoya, Aichi, Japan; 3 Department of Neurosurgery, Andhra Medical College, Maharanipeta, Visakhapatnam, India; 4 Department of Neurosurgery, Inner Mongolia People's Hospital, Hohhot, China; 5 Department of Neurosurgery, Fuchu Keijinkai Hospital, Fuchu City, Tokyo, Japan; 6 Normal Pressure Hydrocephalus Center, Chiba Kashiwa Tanaka Hospital, Kashiwa City, Chiba, Japan; 7 Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan
AIM: A lack of published surgical experience and higher symptomatic recurrence than previously recognized prompted the authors to present their experience with the surgical treatment of unruptured intracranial dissecting aneurysms (UIDAs).
METHODS: Hospital records, neuroimaging studies, operative reports, and follow-up records were retrospectively reviewed. Four patients with vertebral - posterior inferior cerebellar artery (VA-PICA) UIDAs surgically treated between September 2014 and September 2015 were included in the study along with a review of the literature.
RESULTS: There were 3 men and 1 woman in the studied group, their age ranging from 42 to 66 years. Three presented with chronic headache, and in one the dissecting aneurysm was detected incidentally. All patients underwent surgical exploration of the lesion with proximal clipping of the parent artery through a far-lateral suboccipital craniotomy with or without partial condylar resection. In two patients (Cases 1 and 4) an occipital artery (OA)-PICA bypass was performed. Case 1 had a nasal cerebrospinal fluid (CSF) leak and loss of sweet taste postoperatively. The CSF leak was successfully treated conservatively and loss of sweet taste gradually improved. All patients reached a modified Rankin scale of 0-1 at discharge. The follow-up period ranged from 1 to 28 weeks with a mean of 17 weeks. No hemorrhagic or ischemic complications were observed during the follow-up period.
CONCLUSIONS: The surgical treatment of VA-PICA UIDAs has acceptable risk regarding perioperative mortality and morbidity. The incidence of aneurysmal recurrence or the need for retreatment seems to be less than that associated with anticoagulation/antiplatelet therapy or endovascular treatment.