Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
World Neurosurg. 2019 Aug;128:444-447. doi: 10.1016/j.wneu.2019.05.146. Epub 2019 May 25.
Ruptured vertebral artery dissecting aneurysms (VADAs) involving the posterior inferior cerebellar artery (PICA) are the most difficult to treat among variations of VADAs but require prompt treatment. The major challenge is to preserve the PICA while occluding the aneurysm. Despite advances in the management of ruptured VADAs involving the PICA, each treatment, whether it is combined or not, is associated with a significant degree of risk.
This study presents 4 cases of ruptured VADAs involving the PICA that were successfully treated using a staged, combined method. Embolization of the rupture point in the acute stage was followed 3-4 weeks later by occlusion of the proximal vertebral artery (VA) and PICA origin after occipital artery-PICA bypass in the chronic stage.
Although it is sometimes very difficult to determine the exact rupture point of VADAs, ruptures tend to occur at distal segments of a dissecting aneurysm presenting as bleb. Also, when planning a trapping of the VA, careful examination of angiography is needed to assess the contralateral VA and rupture point. Our staged and combined strategy may provide another valuable treatment option for treating VADAs involving the PICA with special emphasis on the safety and efficacy in our method.
椎动脉夹层动脉瘤（VADA）破裂涉及小脑后下动脉（PICA）是 VADA 变异中最难以治疗的，但需要及时治疗。主要的挑战是在闭塞动脉瘤的同时保留 PICA。尽管在治疗涉及 PICA 的破裂 VADA 方面取得了进展，但每种治疗方法，无论是联合还是非联合，都存在相当大的风险。
本研究介绍了 4 例成功采用分期联合方法治疗的涉及 PICA 的破裂 VADA。在急性期对破裂点进行栓塞，3-4 周后在慢性期行枕动脉-PICA 旁路后闭塞椎动脉（VA）和 PICA 起源。
尽管有时很难确定 VADA 的确切破裂点，但破裂点往往发生在夹层动脉瘤的远端，表现为小泡。另外，在计划 VA 夹闭时，需要仔细检查血管造影以评估对侧 VA 和破裂点。我们的分期联合策略可能为治疗涉及 PICA 的 VADA 提供另一种有价值的治疗选择，特别强调了我们方法的安全性和有效性。
