Management of posterior fossa dissecting aneurysms

Abstract

Treatment and prognosis of 14 patients of posterior fossa arterial dissections (AD) and dissecting aneurysms (DA) in one institution was reviewed. Internal trapping of aneurysm was performed for six patients presenting with SAH (three Vertebral, one posterior cerebral, one posterior inferior cerebellar, one anterior inferior cerebellar DA). The patency of the parent arteries was preserved in four DA patients with SAH (two Vertebral, two Basilar DA), 1 incidental vertebral DA, and one DA patient with brainstem infarction using stents and coils (four patients) or coils only (two patient). Proximal occlusion of parent artery was performed in a vertebral DA with SAH. One patient with a superior cerebellar DA presented with a midbrain infarct developed SAH with spontaneous occlusion of the aneurysm two weeks later. Of the 14 cases, ten were angiographically stable or cured during a follow up period of four to 70 months. one spontaneously resolved and two recurred. There was one death.

Figure 1

(Patient 2). A) Right VDA involving PICA is demonstrated. 2 Neuroform 2 stents (4x15 mm and 4x20 mm) were deployed within each other followed by insertion of 2 GDC coils. B) The coil mass is confined to the false aneurysm sac by the 2 stents preserving the vertebral artery and the PICA and remained stable at 24 months follow-up angiogram.

Figure 2

(Patient 5). A) Residual aneurysm sac after partial clipping of a right vertebral DA. B) A 4x20 mm Neuroform three stent was inserted across the neck and overlapped the PICA origin. A total of 20 coils were deployed resulting in nearly complete occlusion of the sac. C) nine months later, a recurrent DA (arrow) has developed opposite to the now occluded initial sac. After tolerating 30 minutes of BTO, two Goldbal2 balloons were detached at C2. D) Despite reopening of the right vertebral due to balloon deflation, the DA was significantly occluded seven months after POPA and 19 months after first treatment.