An Unusual Posttraumatic Pseudoaneurysm of Intracranial Segment (V4) of the Vertebral Artery

Abstract

Traumatic pseudoaneurysm of the vertebral artery is an uncommon and one of the most difficult lesions to treat. Posttraumatic vertebral artery pseudoaneurysm is located mostly extracranially, and its intracranial occurrence is exceedingly rare. We report a case of an 18-year-old man who underwent successful treatment of posttraumatic intracranial pseudoaneurysm of V4 segment of the vertebral artery by endovascular embolization. The patient who sustained trauma in a road accident presented with the complaints of headache, giddiness, and vomiting for the last 13 days. On admission, he was conscious but drowsy with no focal neurologic deficit. CT scan of the brain was suggestive of no significant intracranial abnormality. As the patient had headache, vomiting, and drowsiness, the CT was unable to explain his clinical picture, so CT angiography was performed to exclude vascular abnormality. CT angiography of the brain was suggestive of left vertebral artery aneurysm arising from V4 segment of the left vertebral artery. DSA showed a large pseudoaneurysm arising from left V4 segment of the vertebral artery near origin of PICA. Because of its difficult location, surgical treatment is less preferable as compared with endovascular treatment. The patient underwent endovascular coiling of pseudoaneurysm. Postcoiling DSA showed complete occlusion of pseudoaneurysm. The patient had uneventful postoperative period and showed good recovery.

Keywords

pseudoaneurysms - vertebral artery - intracranial - extracranial - endovascular

• References

• 1 Matas R. Traumatisms and traumatic aneurysms of the vertebral artery and their surgical treatment, with report of a cured case. Ann Surg 1893; 18 (5) 477-521
• 2 Shimizu J, Nakagawa Y, Fuji Y, Nakase H, Mannen T. [Wallenberg's syndrome due to vertebral artery dissection following minimal neck injury—report of two cases] [in Japanese]. Rinsho Shinkeigaku 1992; 32 (4) 430-435
• 3 Jeffery P. Immelman E, Beningneld S. A review of the management of vertebral artery injury. Eur J Vasc Endovasc Surg. 1995; 10: 391-393
• 4 Katirji MB, Reinmuth OM, Latchaw RE. Stroke due to vertebral artery injury. Arch Neurol 1985; 42 (3) 242-248
• 5 Anxionnat R, de Melo Neto JF, Bracard S , et al. Treatment of hemorrhagic intracranial dissections. Neurosurgery 2003; 53 (2) 289-300 , discussion 300–301
• 6 Molnar RG, Naslund TC. Vertebral artery surgery. Surg Clin North Am 1998; 78 (5) 901-913
• 7 Reid JDS, Weigelt JA. Forty-three cases of vertebral artery trauma. J Trauma 1988; 28 (7) 1007-1012
• 8 Lee JW, Jung JY, Kim YB, Huh SK, Kim DI, Lee KC. Spontaneous dissecting aneurysm of the intracranial vertebral artery: management strategies. Yonsei Med J 2007; 48 (3) 425-432
• 9 MacKay CI, Han PP, Albuquerque FC, McDougall CG. Recurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report. Neurosurgery 2003; 53 (3) 754-759 , discussion 760–761