Endovascular treatment of symptomatic intradural vertebral dissecting aneurysms

BACKGROUND AND PURPOSE: The purpose of this study was to report our experience with endovascular treatment of 14 patients with symptomatic intradural vertebral dissecting aneurysms. MATERIALS AND METHODS: Between January 2000 and January 2006, 14 patients with symptomatic intradural dissecting vertebral aneurysms were treated. A total of 756 (568 ruptured, 188 unruptured) endovascular treated aneurysms (incidence, 1.9%) were treated during this period. There were 7 female and 7 male patients with a mean age of 48 years (age range, 10-64 years). Thirteen patients (93%) presented with subarachnoid hemorrhage (SAH) and 1 (7%) presented with acute symptoms of mass effect on the brain stem. RESULTS: Treatment consisted of coil occlusion of the dissected arterial segment including the aneurysm (internal coil trapping) in 13 of 14 patients and stent placement over the aneurysm as the only therapy in 1 patient. All aneurysms and occluded arterial segments remained occluded on follow-up imaging at 6 to 13 months, and none of the patients had infarctions in the medulla or territory of the posterior inferior cerebellar artery. Clinical outcome was excellent in 11 patients; 3 had cognitive impairment after SAH but were independent in daily activities. There were no episodes of recurrent hemorrhage. CONCLUSION: Intradural vertebral dissecting aneurysms presenting with SAH should be treated promptly because of the high risk of recurrent hemorrhage. In our experience, trapping of the dissected segment with coils was straightforward, could be done in most patients, and was effective in preventing rebleeding. In our opinion, only in exceptional circumstances are more sophisticated techniques aimed at preservation of the parent artery necessary.