Vertebral artery dissecting aneurysms (VADA) are challenging disorders for neurosurgeons. Between December 2005 and May 2010, we treated 12 patients for DA of the intracranial VA. Three were treated by open surgery, seven underwent endovascular manipulation, and two were conservatively managed. Nine patients presented with subarachnoid hemorrhage from the ruptured aneurysm, and of these, two experienced abrupt re-hemorrhage and three presented with symptoms of brainstem ischemia. One of the two patients with a re-hemorrhage underwent conservative management and died in hospital of re-bleeding at 30 days after initial presentation. No postoperative neurological deficits occurred in patients treated by open surgery or via an endovascular approach. No re-hemorrhage or ischemic symptoms were observed in the 11 remaining patients during the mean 29-month (range: 14-54-month) follow-up. The chosen management strategy should be developed according to the patient's clinical condition and imaging results. Endovascular treatment, which includes several techniques, is the first choice for most patients.
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Aberrant anatomical variation of the vertebral artery (VA) from an internal carotid artery (ICA) is considered a rare finding. The incidence of this phenomenon can lead to patients suffering from posterior circulation neurological deficit if the ICA becomes significantly diseased. VA atypical anatomical origin is considered one of the rare pathologies, not only precipitating neurovascular incidents but equally leading to severe difficulty in VA dissection and surgical exposure, especially in carotid artery procedures.
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