{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T01:51:39Z","timestamp":1780883499641,"version":"3.54.1"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,12]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> The goal of this study was to implement an algorithm for and assess the multimodal (endovascular and microsurgical) treatment of patients with ruptured dissecting aneurysms of the vertebral artery (VA) during the acute stage.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> During a 4-year period, the authors treated 19 ruptured dissecting aneurysms of the VA during the acute stage, within 3 days after the hemorrhage. Factors guiding management decisions were tolerance of the test occlusion and the site of the dissection. The algorithm takes into account these factors to select among treatment options, that is, trapping of the VA with Guglielmi Detachable Coils (GDCs); trapping of the VA and revascularization of the posterior inferior cerebellar artery (PICA); trapping of the VA and VA\u2014posterior cerebral artery (PCA) anastomosis; and trapping of the VA, VA\u2014PCA anastomosis, and revascularization of the PICA. Of the 15 aneurysms without PICA involvement, 14 were treated by trapping of the VA with GDCs and one by trapping of the VA and a VA\u2014PCA bypass. The other four aneurysms with PICA involvement were treated by VA trapping and PICA revascularization. There was no episode of recurrent hemorrhage or ischemia during the posttreatment follow-up period. Although lateral medullary syndrome developed as a permanent complication in one patient, a good recovery was made by the other 18 patients by 6 months after the ictus.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> The factors that determine the appropriate treatment for ruptured dissecting aneurysms of the VA are tolerance of a test occlusion and the site of dissection. Favorable patient outcomes can be achieved when this algorithm is used.<\/jats:p>","DOI":"10.3171\/jns.2003.99.6.0960","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T17:49:07Z","timestamp":1242236947000},"page":"960-966","source":"Crossref","is-referenced-by-count":91,"title":["Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage"],"prefix":"10.3171","volume":"99","author":[{"given":"Jun-ichiro","family":"Hamada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Kai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motohiro","family":"Morioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigetoshi","family":"Yano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatemi","family":"Todaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukitaka","family":"Ushio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Stroke","first-page":"1628","article-title":"Rebleeding from intracranial dissecting aneurysm in the vertebral artery.","volume":"21","author":"Aoki","year":"1990"},{"key":"b2","series-title":"J Neurosurg","first-page":"882","article-title":"Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature.","volume":"61","author":"Berger","year":"1984"},{"key":"b3","series-title":"Neurol Res","first-page":"1","article-title":"Neurosurgical extracranial-intracranial bypass for stroke: with 400 cases.","volume":"5","author":"Chater","year":"1983"},{"key":"b4","series-title":"J Neurosurg","first-page":"325","article-title":"Subarachnoid hemorrhage from intracranial dissecting aneurysm.","volume":"60","author":"Friedman","year":"1984"},{"key":"b5","series-title":"J Neurosurg","first-page":"183","article-title":"Endovascular treatment of vertebral artery dissections and pseudoaneurysms.","volume":"79","author":"Halbach","year":"1993"},{"key":"b6","series-title":"J Neurosurg","first-page":"867","article-title":"Vertebral artery-posterior inferior cerebellar artery bypass with a superficial temporal artery graft to treat aneurysms involving the posterior inferior cerebellar artery.","volume":"96","author":"Hamada","year":"2002"},{"key":"b7","series-title":"J Neurosurg","first-page":"14","article-title":"Surgical risk as related to time of intervention in the repair of intracranial aneurysms.","volume":"28","author":"Hunt","year":"1968"},{"key":"b8","series-title":"J Neurosurg","first-page":"259","article-title":"Dissecting aneurysms of the vertebral artery: a management strategy.","volume":"97","author":"Iihara","year":"2002"},{"key":"b9","series-title":"Surg Neurol","first-page":"360","article-title":"Superficial temporal artery to superior cerebellar artery anastomosis via the presigmoid retrolabyrinthine transtentorial approach.","volume":"43","author":"Ito","year":"1995"},{"key":"b10","series-title":"J Neurosurg","first-page":"466","article-title":"Rebleeding from vertebral artery dissection after proximal clipping. Case report.","volume":"77","author":"Kitanaka","year":"1992"},{"key":"b11","series-title":"AJNR","first-page":"11","article-title":"Coil embolization for the treatment of ruptured dissecting vertebral aneurysms.","volume":"22","author":"Kurata","year":"2001"},{"key":"b12","series-title":"J Neurosurg","first-page":"427","article-title":"Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils.","volume":"94","author":"Lylyk","year":"2001"},{"key":"b13","series-title":"J Neurosurg","first-page":"299","article-title":"Microvascular anatomy of foramen caecum medullae oblongatae.","volume":"75","author":"Mahmood","year":"1991"},{"key":"b14","series-title":"Neurosurgery","first-page":"905","article-title":"Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms.","volume":"36","author":"Mizutani","year":"1995"},{"key":"b15","series-title":"J Neurosurg","first-page":"712","article-title":"Pathological mechanism and three-dimensional structure of cerebral dissecting aneurysms.","volume":"94","author":"Mizutani","year":"2001"},{"key":"b16","series-title":"Neurosurgery","first-page":"646","article-title":"Cerebral revascularization using radial artery grafts for the treatment of complex intracranial aneurysms: techniques and outcomes for 17 patients.","volume":"49","author":"Sekhar","year":"2001"},{"key":"b17","series-title":"J Neurosurg","first-page":"540","article-title":"Surgical anatomy of the arteries of the posterior fossa.","volume":"65","author":"Shrontz","year":"1986"},{"key":"b18","series-title":"Neurosurgery","first-page":"377","article-title":"Stents for intracranial aneurysms: the beginning of a new endovascular era?","volume":"43","author":"Wakhloo","year":"1998"},{"key":"b19","series-title":"J Neurosurg","first-page":"183","article-title":"Dissecting aneurysms of the intracranial vertebral artery.","volume":"72","author":"Yamaura","year":"1990"},{"key":"b20","series-title":"J Neurosurg","first-page":"853","article-title":"Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils.","volume":"90","author":"Yamaura","year":"1999"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/99\/6\/article-p960.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/99\/6\/article-p960.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/99\/6\/article-p960.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:15:11Z","timestamp":1679271311000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/99\/6\/article-p960.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,12]]},"references-count":20,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/jns.2003.99.6.0960","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2003,12]]}}}