Download PDF
Skull Base 2009; 19(3): 209-218
DOI: 10.1055/s-0028-1114296
ORIGINAL ARTICLE

© Thieme Medical Publishers

Spontaneous Intradural Vertebral Artery Dissection: A Single-Center Experience and Review of the Literature

Hasan Kocaeli1 , Chiraz Chaalala1 , Norberto Andaluz3 , 4 , Mario Zuccarello1 , 2
  • 1Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 2The Neuroscience Institute and Mayfield Clinic, Cincinnati, Ohio
  • 3Department of Neurosurgery, University of South Florida, Tampa, Florida
  • 4James A. Haley Veterans Hospital, Tampa, Florida
Further Information

Publication History

Publication Date:
09 January 2009 (online)

    Permissions and Reprints

ABSTRACT

Objectives: To define the natural history of spontaneous intracranial vertebral artery dissections (VADs) and to review current treatment strategies. Material and methods: We searched the MEDLINE database for all existing English and French literature on VADs through January 2008. Keywords employed were intradural/intracranial vertebral artery dissection, vertebral artery dissection, and vertebral artery dissection treatment. We also reviewed our series of patients with spontaneous VAD treated in the past 5 years. Data were collected, categorized, and analyzed. Results: In our sample of 457 patients, men were more frequently affected than women, and the mean age was 51.8 years. The majority of patients (79%) presented with subarachnoid hemorrhage (SAH). We experienced a high incidence (37%) of recurrent SAH, particularly within the first 24 hours after SAH first occurred. Angiographic fusiform dilatation and pearl-and-string lesions were the most common finding. Patients who presented with SAH fared worse than those who presented with ischemia. Conclusions: Due to a high rate of recurrent bleeding, we concluded that early treatment by either surgical or endovascular route is indicated in patients who present with SAH secondary to spontaneous intradural VADs. Treatment decisions should take into account the site and type of dissection, vertebral artery dominance, and involvement of posterior inferior cerebellar artery.

KEYWORDS

Vertebral artery - arterial dissection - intradural vertebral artery - vertebral artery dissection - vertebral artery dissection treatment

REFERENCES

  • 1 Mokri B, Houser O W, Sandok B A, Piepgras D G. Spontaneous dissections of the vertebral arteries.  Neurology. 1988;  38 880-885
    PubMedGoogle Scholar
  • 2 Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T. Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms.  Neurosurgery. 1995;  36 905-911
    CrossrefPubMedGoogle Scholar
  • 3 Friedman A H, Drake D G. Subarachnoid hemorrhage from intracranial dissecting aneurysms.  J Neurosurg. 1984;  60 325-334
    CrossrefPubMedGoogle Scholar
  • 4 Arnold M, Bousser M G, Fahrni G et al.. Vertebral artery dissection: presenting findings and predictor of outcome.  Stroke. 2006;  37 2499-2503
    CrossrefPubMedGoogle Scholar
  • 5 Yoon W, Seo J J, Kim T S, Do H M, Jayaraman M V, Marks M P. Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment.  Eur Radiol. 2007;  17 983-993
    CrossrefPubMedGoogle Scholar
  • 6 Zhao W Y, Krings T, Alvarez H, Ozanne A, Holmin S, Lasjaunias P. Management of spontaneous hemorrhagic intracranial vertebrobasilar dissection: review of 21 consecutive cases.  Acta Neurochir (Wien). 2007;  149 585-596
    CrossrefPubMedGoogle Scholar
  • 7 Yamaura A. Diagnosis and treatment of vertebral aneurysms.  J Neurosurg. 1988;  69 345-349
    CrossrefPubMedGoogle Scholar
  • 8 Yoshimoto Y, Wakai S. Unruptured intracranial vertebral artery dissection: clinical course and serial radiographic imaging.  Stroke. 1997;  28 370-374
    PubMedGoogle Scholar
  • 9 Nakagawa K, Touho H, Morisako T et al.. Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings.  J Neurosurg. 2000;  93 19-25
    PubMedGoogle Scholar
  • 10 Anxionnat R, de Melo Neto J F, Bracard S et al.. Treatment of hemorrhagic intracranial dissections.  Neurosurgery. 2003;  53 289-301
    CrossrefPubMedGoogle Scholar
  • 11 Hamada J, Kai Y, Morioka M, Yano S, Todaka T, Ushio Y. Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage.  J Neurosurg. 2003;  99 960-966
    CrossrefPubMedGoogle Scholar
  • 12 Garnier P, Demasles S, Januel A C, Michel D. Intracranial extension of extracranial vertebral artery dissections. A review of 16 cases.  Rev Neurol (Paris). 2004;  160 679-684
    CrossrefPubMedGoogle Scholar
  • 13 Kim C H, Son Y J, Paek S H et al.. Clinical analysis of vertebrobasilar dissection.  Acta Neurochir (Wien). 2006;  148 395-404
    CrossrefPubMedGoogle Scholar
  • 14 Yamada M, Kitahara T, Kurata A, Fujii Y, Miyasaka Y. Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients.  J Neurosurg. 2004;  101 25-30
    PubMedGoogle Scholar
  • 15 Shimoji T, Bando K, Nakajima K, Ito K. Dissecting aneurysm of the vertebral artery: report of seven cases and angiographic findings.  J Neurosurg. 1984;  61 1038-1046
    PubMedGoogle Scholar
  • 16 Sasaki O, Ogawa H, Koike T, Koizumi T, Tanaka R. A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery.  J Neurosurg. 1991;  75 874-882
    CrossrefPubMedGoogle Scholar
  • 17 Anxionnat R, Roy D, Bracard S et al.. Dissection of intracranial vertebral arteries revealed by subarachnoid hemorrhage: report of seven cases.  J Neuroradiol. 1994;  21 1-16
    PubMedGoogle Scholar
  • 18 Pozzati E, Andreoli A, Limoni P, Casmiro M. Dissecting aneurysms of the vertebrobasilar system: study of 16 cases.  Surg Neurol. 1994;  41 119-124
    CrossrefPubMedGoogle Scholar
  • 19 Tsukahara T, Wada H, Satake K, Yaoita H, Takahashi A. Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage.  Neurosurgery. 1995;  36 914-919
    PubMedGoogle Scholar
  • 20 Sano H, Kato Y, Okuma I et al.. Classification and treatment of vertebral dissecting aneurysm.  Surg Neurol. 1997;  48 598-605
    CrossrefPubMedGoogle Scholar
  • 21 Han D H, Kwon O K, Oh C W. Clinical characteristics of vertebrobasilar artery dissection.  Neurol Med Chir (Tokyo). 1998;  38(Suppl) 107-113
    PubMedGoogle Scholar
  • 22 Manabe H, Hatayama T, Hasegawa S, Islam S M, Suzuki S. Coil embolisation for ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery.  Neuroradiology. 2000;  42 384-387
    CrossrefPubMedGoogle Scholar
  • 23 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. 2001;  22 11-18
    PubMedGoogle Scholar
  • 24 Mizutani T, Miki Y, Kojima H, Suzuki H. Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms.  Neurosurgery. 1999;  45 253-260
    CrossrefPubMedGoogle Scholar
  • 25 Iihara K, Sakai N, Murao K et al.. Dissecting aneurysms of the vertebral artery: a management strategy.  J Neurosurg. 2002;  97 259-267
    CrossrefPubMedGoogle Scholar
  • 26 Naito I, Iwai T, Sasaki T. Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage.  Neurosurgery. 2002;  51 930-938
    CrossrefPubMedGoogle Scholar
  • 27 Rabinov J D, Hellinger F R, Morris P P, Ogilvy C S, Putman C M. Endovascular management of vertebrobasilar dissecting aneurysms.  AJNR Am J Neuroradiol. 2003;  24 1421-1428
    PubMedGoogle Scholar
  • 28 Ahn J Y, Chung S S, Lee B H et al.. Treatment of spontaneous arterial dissections with stent placement for preservation of the parent artery.  Acta Neurochir (Wien). 2005;  147 265-273
    CrossrefPubMedGoogle Scholar
  • 29 Ramgren B, Cronqvist M, Romner B, Brandt L, Holtas S, Larsson E M. Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients.  Neuroradiology. 2005;  47 97-104
    CrossrefPubMedGoogle Scholar
  • 30 Sheah K, Lim W, Chan C. Endovascular and surgical management of vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage: medium-term experience.  Ann Acad Med Singapore. 2005;  34 262-270
    PubMedGoogle Scholar
  • 31 Sugiu K, Tokunaga K, Watanabe K et al.. Emergent endovascular treatment of ruptured vertebral artery dissecting aneurysms.  Neuroradiology. 2005;  47 158-164
    CrossrefPubMedGoogle Scholar
  • 32 Yuki I, Murayama M, Vinuela F. Endovascular management of dissecting vertebrobasilar artery aneurysms in patients presenting with acute subarachnoid hemorrhage.  J Neurosurg. 2005;  103 649-655
    CrossrefPubMedGoogle Scholar
  • 33 Albuquerque F C, Fiorella D J, Han P P, Deshmukh V R, Kim L J, McDougall C G. Endovascular management of intracranial vertebral artery dissecting aneurysms.  Neurosurg Focus. 2005;  18 E3
    PubMedGoogle Scholar
  • 34 Ahn J Y, Han I B, Kim T G et al.. Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling.  AJNR Am J Neuroradiol. 2006;  27 1514-1520
    PubMedGoogle Scholar
  • 35 Lee J W, Jung J Y, Kim Y B, Huh S K, Kim D I, Lee K C. Spontaneous dissecting aneurysm of the intracranial vertebral artery: management strategies.  Yonsei Med J. 2007;  48 425-432
    CrossrefPubMedGoogle Scholar
  • 36 Kitanaka C, Tanaka J, Kuwahara M, Teraoka A, Sasaki T, Takakura K. Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography.  J Neurosurg. 1994;  80 667-674
    PubMedGoogle Scholar
  • 37 Yonas H, Agamanolis D, Takaoka Y, White R J. Dissecting intracranial aneurysms.  Surg Neurol. 1977;  8 407-415
    PubMedGoogle Scholar
  • 38 Mizutani T, Kojima H, Asamoto S, Miki Y. Pathological mechanism and three-dimensional structure of cerebral dissecting aneurysms.  J Neurosurg. 2001;  94 712-717
    CrossrefPubMedGoogle Scholar
  • 39 Endo S, Nishijima M, Nomura H, Takaku A, Okada E. A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature.  Neurosurgery. 1993;  33 732-738
    PubMedGoogle Scholar
  • 40 Greselle J F, Zenteno M, Kien P, Castel J P, Caille J M. Dissection spontanee du systeme vertebro-basilaire. A propos de 18 cas chez 15 patients.  J Neuroradiol. 1987;  14 115-123
    PubMedGoogle Scholar
  • 41 Lucas C, Leclerc X, Pruvo J P, Leys D. Dissections arterielles vertebrales: suivi par angiographie par resonance magnetique et injection de gadolinium.  Rev Neurol (Paris). 2000;  156 1096-1105
    PubMedGoogle Scholar
  • 42 Sakata N, Takebayashi S, Kojima M, Masawa N, Suzuki K, Takatama M. Pathology of a dissecting aneurysm.  Neuropathology. 2000;  20 104-108
    CrossrefPubMedGoogle Scholar

Mario ZuccarelloM.D. 

c/o Norberto Andaluz, M.D. Department of Neurosurgery

University of South Florida. 13,000 Bruce B. Downs Blvd. ML112, Tampa, FL 33612

Email: nandaluz@health.usf.edu

      >