Intracranial dissecting aneurysms of the posterior circulation

TLDR

Dissecting aneurysms of the intracranial posterior circulation are rare, often affect healthy young adults, present most commonly with suboccipital headache, are difficult to diagnose due to inconsistent angiographic features, and carry a high morbidity and mortality rate. The study proposes that a deficit in the inner vessel layers is the source of posterior circulation dissecting aneurysms. Management depends on dissection location, with options including ligation, trapping, or vessel reinforcement, while anticoagulation is contraindicated.

Abstract

✓ Dissecting aneurysms of the intracranial posterior circulation are unusual lesions that affect otherwise healthy young adults, are difficult to diagnose and manage, and carry a high morbidity and mortality rate. Headache in the suboccipital-posterior cervical region is the most common presenting symptom. The dissection usually occurs between the intima or internal elastic lamina and the media; subadventitial dissection does occur and accounts for the infrequent finding of subarachnoid hemorrhage. A deficit in the inner layers of the vessel is the proposed source of dissection. The angiographic features are inconsistent, although an irregularly narrowed arterial segment with proximal and/or distal dilatation are typical findings. Depending on the location of the dissection, the surgical options are: ligation, trapping, or reinforcement of exposed abnormal portions of the vessel. Anticoagulation therapy is not indicated in the management of this lesion.