Abstract
The natural history and treatment strategy of intracranial dissecting aneurysm in the vertebrobasilar (V-B) system remains controversial. We report 10 cases of ruptured intracranial dissecting aneurysm in the V-B system and review the literature with focus on the analysis of serial angiographic findings, treatment, and long-term outcome.All patients were conservatively managed under careful blood pressure control, and angiography was carried out depending on the patient's condition. Surgical or endovascular intervention was chosen when morphological changes leading to rebleeding were recognized by follow-up angiography. Craniotomy in 3 patients and coiling in 3 patients was performed. No rebleeding occurred during the follow-up period in any of the 10 patients, and all cases resulted in favorable outcome.These results suggested that ruptured intracranial dissecting aneurysms of the V-B system could be treated conservatively, avoiding rebleeding under careful control of blood pressure in the acute stage. Alternatively, surgical or endovascular treatment should be considered if angiographical changes that may lead to risk of rebleeding are noted.
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