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Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery

Nakao Ota Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Rokuya Tanikawa Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Hirotake Eda Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Takashi Matsumoto Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Takanori Miyazaki Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Hidetoshi Matsukawa Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Takeshi Yanagisawa Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Go Suzuki Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Shiro Miyata Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Jumpei Oda Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Kosumo Noda Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Toshiyuki Tsuboi Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Rihei Takeda Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Hiroyasu Kamiyama Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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Sadahisa Tokuda Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan

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OBJECTIVE

Bilateral vertebral artery dissecting aneurysms (VADAs) have a poor prognosis because progressive enlargement of the aneurysms compresses the brainstem or causes subarachnoid hemorrhage. The trapping of 1 vertebral artery (VA) places increased hemodynamic stress on the contralateral VA and may lead to enlargement and rupture. Therefore, management strategies are controversial. This study describes a radical treatment for bilateral VADAs using bypass surgery.

METHODS

Seven patients with bilateral VADAs were included. Three patients were treated by trapping of 1 VA via coiling or clipping at another hospital; the previously treated VA in 1 patient and the contralateral untreated VA in 2 patients subsequently enlarged. The other 4 patients presented without previous intervention and progressive enlargement of the aneurysms.

RESULTS

The post–coil embolization patients underwent V3–posterior cerebral artery (PCA) bypass and trapping. The other 4 patients underwent VA reconstruction via V3–V4 or V4–V4 bypass, with contralateral trapping on a separate day in 3 patients and observation in 1 patient. Perioperative complications included 1 case of cerebrospinal fluid leakage for which the patient required an additional operation, 1 case of dysphagia and facial palsy due to sigmoid sinus thrombosis, and 1 case of dysphagia. The long-term outcomes of these patients were favorable.

CONCLUSIONS

Patients with bilateral VADAs require treatment on both sides. If VA trapping is performed first, the treatment options for the other side are limited to V3-PCA bypass and trapping. This procedure is effective; however, it is also invasive and technically difficult. In cases of bilateral VADAs in which it is feasible to reconstruct 1 side, the best approach is to begin by reconstructing the VA that appears technically easiest, followed by trapping of the contralateral VADA. This strategy allows enough time to suture vessels because contralateral reverse flow is maintained.

ABBREVIATIONS

AICA = anterior inferior cerebellar artery; CN = cranial nerve; CTA = CT angiography; mRS = modified Rankin Scale; OA = occipital artery; PCA = posterior cerebral artery; PICA = posterior inferior cerebellar artery; RAG = radial artery graft; SAH = subarachnoid hemorrhage; SCA = superior cerebellar artery; STA = superficial temporal artery; SVG = saphenous vein graft; VA = vertebral artery; VADA = VA dissecting aneurysm.
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  • 1

    Ahn JY, , Han IB, , Kim TG, , Yoon PH, , Lee YJ, & Lee BH, et al.: Endovascular treatment of intracranial vertebral artery dissections with stent placement or stentassisted coiling. AJNR Am J Neuroradiol 27:15141520, 2006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Batjer HH, & Purdy PD: Enlarging thrombosed aneurysm of the distal basilar artery. Neurosurgery 26:695700, 1990

  • 3

    Chang SD, , Marks MP, & Steinberg GK: Recanalization and rupture of a giant vertebral artery aneurysm after hunterian ligation: case report. Neurosurgery 44:11171121, 1999

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Fiorella D, , Hsu D, , Woo HH, , Tarr RW, & Nelson PK: Very late thrombosis of a pipeline embolization device construct: case report. Neurosurgery 67:onsE313onsE314, 2010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Fiorella D, , Kelly ME, , Albuquerque FC, & Nelson PK: Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device. Neurosurgery 64:212217, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Fiorella D, , Woo HH, , Albuquerque FC, & Nelson PK: Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62:11151121, 2008

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Halbach VV, , Higashida RT, , Dowd CF, , Barnwell SL, , Fraser KW, & Smith TP, et al.: The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg 80:659666, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    He M, , Zhang H, , Lei D, , Mao BY, , You C, & Xie XD, et al.: Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms. J Neurosurg 110:418426, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Iihara K, , Murao K, , Sakai N, , Soeda A, , Ishibashi-Ueda H, & Yutani C, et al.: Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum. Case report. J Neurosurg 98:407413, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Iihara K, , Sakai N, , Murao K, , Sakai H, , Higashi T, & Kogure S, et al.: Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97:259267, 2002

  • 11

    Inoue A, , Kohno K, , Takechi A, , Kohno K, , Matsushige T, & Takeda T: Bilateral vertebral artery dissecting aneurysm with subarachnoid hemorrhage treated with staged bilateral vertebral artery coil occlusion: a case report. Surg Neurol 70:319322, 2008

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kakino S, , Ogasawara K, , Kubo Y, , Otawara Y, , Tomizuka N, & Suzuki M, et al.: Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion. Surg Neurol 61:185189, 2004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Katsuno M, , Mizunari T, , Kobayashi S, , Takahashi H, & Teramoto A: Rupture of a vertebral artery dissecting aneurysm developing immediately after trapping of a dissecting aneurysm on the contralateral vertebral artery: case report. Neurol Med Chir (Tokyo) 49:468470, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Katsuno M, , Tanikawa R, , Uemori G, , Kawasaki K, , Izumi N, & Hashimoto M: Occipital artery-to-posterior inferior cerebellar artery anastomosis with multiple-layer dissection of suboccipital muscles under a reverse C-shaped skin incision. Br J Neurosurg 29:401405, 2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Kawashima M, , Matsushima T, , Inoue T, , Mineta T, , Masuoka J, & Hirakawa N: Microvascular decompression for glossopharyngeal neuralgia through the transcondylar fossa (supracondylar transjugular tubercle) approach. Neurosurgery 66:6 Suppl Operative 275280, 2010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Klisch J, , Turk A, , Turner R, , Woo HH, & Fiorella D: Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. AJNR Am J Neuroradiol 32:627632, 2011

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Kobayashi N, & Hiroyasu K: Reconstruction of the basilar arterial system: Methods of high-flow bypass in posterior cranial fossa. Surg Cereb Stroke (Jpn) 27:270276, 1999

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Koh JS, , Ryu CW, , Lee SH, , Bang JS, & Kim GK: Bilateral vertebral-artery-dissecting aneurysm causing subarachnoid hemorrhage cured by staged endovascular reconstruction after occlusion. Cerebrovasc Dis 27:202204, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Kono K, , Shintani A, , Fujimoto T, & Terada T: Stent-assisted coil embolization and computational fluid dynamics simulations of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage: case report. Neurosurgery 71:E1192E1201, 2012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Kubota H, , Tanikawa R, , Katsuno M, , Izumi N, , Noda K, & Ota N, et al.: Vertebral artery-to-vertebral artery bypass with interposed radial artery or occipital artery grafts: surgical technique and report of three cases. World Neurosurg 81:202.e1202.e8, 2014

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Kubota H, , Tanikawa R, , Katsuno M, , Noda K, , Ota N, & Miyata S, et al.: Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note. Acta Neurochir (Wien) 155:15171524, 2013

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Kurata A, , Ohmomo T, , Miyasaka Y, , Fujii K, , Kan S, & Kitahara T: Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22:1118, 2001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Lee KC, , Joo JY, , Lee KS, & Shin YS: Recanalization of completely thrombosed giant aneurysm: case report. Surg Neurol 51:9498, 1999

  • 24

    Lylyk P, , Miranda C, , Ceratto R, , Ferrario A, , Scrivano E, & Luna HR, et al.: Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632643, N6, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Martin AR, , Cruz JP, , Matouk CC, , Spears J, & Marotta TR: The pipeline flow-diverting stent for exclusion of ruptured intracranial aneurysms with difficult morphologies. Neurosurgery 70:1 Suppl Operative 2128, 2012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Matsushima T, & Fukui M: [Lateral approaches to the foramen magnum: with special reference to the transcondylar fossa approach and the transcondylar approach.]. No Shinkei Geka 24:119124, 1996. (Jpn)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Matsushima T, , Kawashima M, , Masuoka J, , Mineta T, & Inoue T: Transcondylar fossa (supracondylar transjugular tubercle) approach: anatomic basis for the approach, surgical procedures, and surgical experience. Skull Base 20:8391, 2010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Mitchell B, , Momin E, , Jou LD, , Shaltoni H, , Morsi H, & Mawad M: Extensive bilateral vertebral artery remodeling following treatment of dissection using pipeline embolic device. J Vasc Interv Neurol 7:58, 2014

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Mizutani T, , Aruga T, , Kirino T, , Miki Y, , Saito I, & Tsuchida T: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905913, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Nagahiro S, , Takada A, , Goto S, , Kai Y, & Ushio Y: Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg 82:796801, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Nashimoto T, , Saito T, , Kurashima A, , Yamashita S, & Honma J: [Case of bilateral vertebral artery dissecting aneurysm presenting with subarachnoid hemorrhage.]. No Shinkei Geka 37:381385, 2009. (Jpn)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Nishimu YA, , Ikeda A, , Sugita R, , Maeda K, , Nakamua S, & Takerroto M, et al.: [Case of spontaneous bilateral VA dissecting aneurysm presenting with SAH.]. No Shinkei Geka 35:583589, 2007. (Jpn)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Otawara Y, , Ogasawara K, , Ogawa A, & Kogure T: Dissecting aneurysms of the bilateral vertebral arteries with subarachnoid hemorrhage: report of three cases. Neurosurgery 50:13721375, 2002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Rabinov JD, , Hellinger FR, , Morris PP, , Ogilvy CS, & Putman CM: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24:14211428, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Sakamoto S, , Ohba S, , Shibukawa M, , Kiura Y, , Okazaki T, & Arita K, et al.: Staged bilateral vertebral artery occlusion for ruptured dissecting aneurysms of the basilar artery: a report of 2 cases. Surg Neurol 64:456461, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Somekawa K, , Nagata K, , Kawamoto S, , Furuya H, , Tanioka D, & Isoo A: [Treatment for the ruptured bilateral vertebral dissecting aneurysms.]. No Shinkei Geka 30:321325, 2002. (Jpn)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Sugita K, , Kobayashi S, , Takemae T, , Tanaka Y, , Okudera H, & Ohsawa M: Giant aneurysms of the vertebral artery. Report of five cases. J Neurosurg 68:960966, 1988

  • 38

    Suh SH, , Kim BM, , Park SI, , Kim DI, , Shin YS, & Kim EJ, et al.: Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. Clinical article. J Neurosurg 111:4852, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Swearingen B, & Heros RC: Fatal rupture of a thrombosed giant basilar artery aneurysm. Surg Neurol 23:299302, 1985

  • 40

    Szikora I, , Berentei Z, , Kulcsar Z, , Marosfoi M, , Vajda ZS, & Lee W, et al.: Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31:11391147, 2010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Tanikawa R, , Sugimura T, , Hino K, , Izumi N, , Mitsui N, & Yamauchi T, et al.: Surgical application of skull base technique for EC-IC bypass to P2 segment. Surg Cereb Stroke (Jpn) 34:440444, 2006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Wilkinson DA, , Wilson TJ, , Stetler WR, & Pandey AS: Subarachnoid haemorrhage with bilateral intracranial vertebral artery dissecting aneurysms treated by staged endovascular stenting. BMJ Case Rep 2013:bcr0320126002, 2013

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Yeung TW, , Lai V, , Lau HY, , Poon WL, , Tan CB, & Wong YC: Long-term outcome of endovascular reconstruction with the Pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 116:882887, 2012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Yoon SM, , Shim JJ, , Kim SH, & Chang JC: Bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage treated by staged coil trapping and covered stents graft. J Korean Neurosurg Soc 51:155159, 2012

    • PubMed
    • Search Google Scholar
    • Export Citation

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