Giant pseudoaneurysm of the extracranial vertebral artery: case report

Gallo, Pasquale; Dalacorte, Amauri; Raupp, Eduardo; Santos, Amir J.; Frank, Marcos R. C.; Saraiva, Glauco A.

doi:10.1590/S0004-282X1996000200019

Abstracts

Pseudoaneurysms of the extracranial vertebral artery are extremely rare due to their deep location and the anatomical protection of this artery. They can be caused by cervical traumas (firearm injuries, sports, hyperextension of the neck and iatrogeny). The authors report the case of a patient who developed a giant pseudoaneurysm of the extracranial vertebral artery after surgery for the removal of a tumor of the cerebellopontine angle in which surgical lesion of the artery occurred. Treatment was performed by endovascular approach. Literature is reviewed and comments are made on the physiopathogeny of the lesion and the different forms of treatment.

aneurysm; vertebral artery aneurysm; endovascular treatment

Os pseudoaneurismas da artéria vertebral extracraniana são extremamente raros pela localização profunda e proteção anatômica desta artéria. Podem ser ocasionados por traumas cervicais (ferimentos por armas de fogo, esportes, hiperextensão do pescoço e iãtrogenias). Os autores relatam o caso de um paciente que desenvolveu um pseudoaneurisma gigante da artéria vertebral extracraniana após cirurgia para retirada de tumor de ângulo ponto cerebelar em que ocorreu a lesão cirúrgica desta artéria e cujo tratamento foi endovascular. A literatura é revisada e são feitas considerações sobre a fisiopatogenia da lesão e as várias formas de tratamento.

aneurisma; aneurisma da artéria vertebral; tratamento endovascular

Giant pseudoaneurysm of the extracranial vertebral artery: case report

Pseudoaneurisma gigante da artéria vertebral extracraniana: relato de caso

Pasquale Gallo; Amaurida Lacorte; Eduardo Raupp; Amir J. Santos; Marcos R. C. Frank; Glauco A. Saraiva

Department of Neurosurgery and Department of Neuroradiology, Cristo Redentor Hospital, Porto Alegre, Brazil

ABSTRACT

Pseudoaneurysms of the extracranial vertebral artery are extremely rare due to their deep location and the anatomical protection of this artery. They can be caused by cervical traumas (firearm injuries, sports, hyperextension of the neck and iatrogeny). The authors report the case of a patient who developed a giant pseudoaneurysm of the extracranial vertebral artery after surgery for the removal of a tumor of the cerebellopontine angle in which surgical lesion of the artery occurred. Treatment was performed by endovascular approach. Literature is reviewed and comments are made on the physiopathogeny of the lesion and the different forms of treatment.

Key words:aneurysm, vertebral artery aneurysm.endovascular treatment

RESUMO

Os pseudoaneurismas da artéria vertebral extracraniana são extremamente raros pela localização profunda e proteção anatômica desta artéria. Podem ser ocasionados por traumas cervicais (ferimentos por armas de fogo, esportes, hiperextensão do pescoço e iãtrogenias). Os autores relatam o caso de um paciente que desenvolveu um pseudoaneurisma gigante da artéria vertebral extracraniana após cirurgia para retirada de tumor de ângulo ponto cerebelar em que ocorreu a lesão cirúrgica desta artéria e cujo tratamento foi endovascular. A literatura é revisada e são feitas considerações sobre a fisiopatogenia da lesão e as várias formas de tratamento.

Palavras-chave: aneurisma, aneurisma da artéria vertebral, tratamento endovascular

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 31-janeiro-1996.

Dr. Pasquale Gallo - Rua Tobias da Silva 99/203 - 90570-020 Porto Alegre RS - Brasil

1. Amaral JF, Grigoriev VE, Dorfman GS, Carney WI Jr. Vertebral artery pseudoaneurysm: a rare complication of subclavian artery catheterization. Arch Surg 1990;125:546-547.
2. Ben-Menachem Y, Fields WS, Cadavid G, Gomez LS, Anderson EC, Fisher RG: Vertebral artery trauma: transcatheter embolization. Am J Neuroradiol 1987;8:501-507.
3. Blickenstaff KL, Weaver FA, Yellin AE, Stain SC, Finck E. Trends in the management of traumatic vertebral artery injuries. Am J Surg 1989;158:101-106.
4. Brodribb AM. Vertebral aneurysm in a case of Ehlers-Danlos syndrome. Br J Surg 1970;57:148-151.
5. Buscaglia LC, Crowhurst HD: Vertebral artery trauma. Am J Surg 1979;138:269-272.
6. Caplan LR, Zarins CK, Hemmati M Spontaneous dissection of the extracranial vertebral arteries. Stroke 1985; 16:1030-1038.
7. Case MES, Archer CR, Hsieh V, Codd JE. Traumatic aneurysm of the vertebral artery: A case report and review of the literature. Angiology 1979;30:138-142.
8. Davidson KC, Weiford EC, Dixon GD. Traumatic vertebral artery pseudoaneurysm following chiropratic manipulation. Radiology 1975;115:651-652.
9. de los Reyes RA, Moser FG, Sachs DP, Boehm FH. Direct repair of an extracranial vertebral artery pseudoaneurysm: case report and review of the literature. Neurosurgery 1990;26:528-533.
10. Detwiler K, Godersky JC, Gentry L. Pseudoaneurysm of the extracranial vertebral artery. J Neurosurg 1987,67:935-939.
11. de Villiers JC, Grant AR. Stab wounds at the craniocervical junction. Neurosurgery 1985; 17:930-936.
12. Dragon R, Saranchak H, Lakin P, Strauch G. Blunt injuries to the carotid and vertebral arteries. Am J Surg 1981; 141:497-500.
13. Drake CG. Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg 1975;43:255-274.
14. Early CB, Shuring AG, Hunt WE. False aneurysm of the vertebral artery: a complication of radon seed implantion. Ann Surg 1966;164:900-904.
15. Edwards A. Ehlers-Danlos syndrome with vertebral artery aneurysm. Proc R Soc Med 1969;62:14-15.
16. Farley HH, Nixon R, Peterson TA, Hitchcock CR. Penetrating wounds of the neck. Am J Surg 1964;108:592-596.
17. Fedele FA, Ho G, Dorman BA. Pseudoaneurysm of the vertebral artery: a complication of rheumatoid cervical spine disease. Arthritis Rheum 1986;29:136-141.
18. Golueke P, Sclafani S, Phillips T, Goldstein A, Scalea T, Duncan A. Vertebral artery injury: diagnosis and management. J Trauma 1987;27:856-865,
19. Hadley MN, Spetzler RF, Masferrer R, Martin NA, Carter LP. Occipital artery to extradural vertebral artery bypass procedure. J Neurosurg 1985;63:622-625,
20. Hanakita J, Suwa H, Nishihara K, lihara K, Sakaida H. Giant pseudoaneurysm of the extracranial vertebral artery sucessfully treated using intraoperative balloon catheters. Neurosurgery 1991;28:738-741.
21. Hatzitheofilou C, Demetriades D, Melissas J, Stewart M, Franklin J. Surgical approaches to vertebral artery injuries. Br J Surg 1988;75:234-237.
22. Hayes P, Gerlock AJ Jr, Cobb CA. Cervical spine trauma: a cause of vertebral artery injury. J Trauma 1980,20:904-905.
23. Heilbrun MP, Ratcheson RA. Multiple extracranial vessel injuries following closed head and neck traumaJ Neurosurg 1972;37:219-223.
24. Heifetz CJ. Traumatic aneurysm of the first portion of the left vertebral artery. Ann Surg 1945; 122:102-110.
25. Heros RC. Cerebellar infarction resulting from traumatic occlusion of a vertebral artery. J Neurosurg 1979;51:111-113.
26. Higashida RT, Halbach VV, Tsai FY, Norman D, Pribram HF, Mehringer CM, Hieshima GB. Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases. AIR 1989; 153:577-582.
27. Hilton-Jones D, Warlow CP: Non-penetrating arterial trauma and cerebral infarction in the young. Lancet 1985; 1:1435-1438.
28. Kanshepolsky J, Danielson H, Flynn RE. Vertebral artery insufficiency and cerebellar infarct due to manipulation of the neck: report of a case. Bull Los Angeles Neurol Soc 1972;37:62-66.
29. Katirji MB, Reinmuth OM, Latchaw RE. Stroke due to vertebral artery injury. Arch Neurol 1985;42:242-248.
30. Kister SJ, Rankow RM: Traumatic aneurysm of the first portion of the left vertebral artery. Plast Reconstr Surg 1966;37:546-549.
31. Krueger BR, Okazaki H. Vertebral-basilar distribution infarction following chiropratic cervical manipulation. Mayo Clin Proc 1980;55:322-332.
32. Matas R. Traumatisms and traumatic aneurysms of the vertebral artery and their surgical treatment, with report of a cured case. Ann Surg 1893;18:477-521.
33. McLean JM, Wright RM, Henderson JP, Lister JR. Vertebral artery rupture associated with closed head injury. J Neurosurgl985;62:135-138.
34. Mehalic T, Farhat SM. Vertebral artery injury from chiropratic manipulation of the neck. Surg Neurol 1974;2:125-129.
35. Meier DE, Brink BE, Fry WJ. Vertebral artery trauma. Arch Surgl981 ;116:236-239.
36. O'Connel JD, Sutton D, Kendall B. Traumatic vertebral artery aneurysm: report of two cases. Br J Radiol 1975,48:670-673.
37. Okawara S, Nibbelink D. Vertebral artery occlusion following hyperextension and rotation of the head. Stroke 1974;5:640-642,
38. Rahimizadeb A, Sabouri-Daylami M, Amir-Moezi N, Haddadian K. Traumatic aneurysm of the extracranial vertebral artery. Neurosurgery 1986;19:628-630.
39. Raskind R, North C. Vertebral artery injuries following chiropratic cervical spine manipulation. Angiology 1990;41:445-452.
40. Reid JDS, Weigelt JA. Forty-three cases of vertebral artery trauma. J Trauma 1988;28:1007-1012.
41. Rich NM, Spencer FC. Carotid and vertebral artery injuries, In Rich NM, Spence FC. Vascular Trauma. Philadelphia: WB Saunders, I978;260-286.
42. Roper PR, Guinto FC, Wolma FJ: Posttraumatic vertebral artery aneurysm and arteriovenous fistula: a case report. Surgery 1984;96:556-559,
43. Ross DA, Olsen WL, Halbach V, Rosegay H, Pitts LH. Cervical root compression by a traumatic pseudoaneurysm of the vertebral artery. Neurosurgery 1988;22:414-417,
44. Schellhas KP, Latchaw RE, Wendling LR, Gold LHA. Vertebro-basilar injuries following cervical manipulations. JAMA 1980;244:1450-1453
45. Sherman DG, Hart RG, Easton JD. Abrupt changes in head position and cerebral infarction. Stroke 1981; I2:2-6.
46. Shintani A, Zervas NT. Consequence of ligation of the vertebral artery. J Neurosurg 1972;36:447-450.
47. Schubiger O, Yasargil MG: Extracranial vertebral aneurysm with neurofibromatosis. Neuroradiology 1978; 15:171 -173.
48. Simeone FA, Goldberg HI. Thrombosis of the vertebral artery from hyperextension injury to the neck. J Neurosurg 1968;29:540-544.
49. Thomas GI, Anderson KN, Hain RF, Merendino KA: The significance of anomalous vertebral-basilar artery communications in operations on the heart and great vessels: an illustrative case with review of the literature. Surgery 1959;46:747-757.
50. Thompson JE, Eilber F, Baker JD. Vertebral artery aneurysm. Surgery 1979;85:583-585.
51. Wiener I, Flye M W. Traumatic false aneurysm of the vertebral artery. J Trauma 1984;24:346-349.
52. Willis BK, Greiner F, Orrison WW, Benzei EC: The incidence of vertebral artery injury after midcervical spine fracture or subluxation.Neurosurgery 1994;34:435-441.
53. Yates PO. Birth trauma to the vertebral arteries. Arch Dis Child 1959;34:436-441.

Publication Dates

Publication in this collection
06 Dec 2010
Date of issue
June 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Amaral JF, Grigoriev VE, Dorfman GS, Carney WI Jr. Vertebral artery pseudoaneurysm: a rare complication of subclavian artery catheterization. Arch Surg 1990;125:546-547.

[2] 2. Ben-Menachem Y, Fields WS, Cadavid G, Gomez LS, Anderson EC, Fisher RG: Vertebral artery trauma: transcatheter embolization. Am J Neuroradiol 1987;8:501-507.

[3] 3. Blickenstaff KL, Weaver FA, Yellin AE, Stain SC, Finck E. Trends in the management of traumatic vertebral artery injuries. Am J Surg 1989;158:101-106.

[4] 4. Brodribb AM. Vertebral aneurysm in a case of Ehlers-Danlos syndrome. Br J Surg 1970;57:148-151.

[5] 5. Buscaglia LC, Crowhurst HD: Vertebral artery trauma. Am J Surg 1979;138:269-272.

[6] 6. Caplan LR, Zarins CK, Hemmati M Spontaneous dissection of the extracranial vertebral arteries. Stroke 1985; 16:1030-1038.

[7] 7. Case MES, Archer CR, Hsieh V, Codd JE. Traumatic aneurysm of the vertebral artery: A case report and review of the literature. Angiology 1979;30:138-142.

[8] 8. Davidson KC, Weiford EC, Dixon GD. Traumatic vertebral artery pseudoaneurysm following chiropratic manipulation. Radiology 1975;115:651-652.

[9] 9. de los Reyes RA, Moser FG, Sachs DP, Boehm FH. Direct repair of an extracranial vertebral artery pseudoaneurysm: case report and review of the literature. Neurosurgery 1990;26:528-533.

[10] 10. Detwiler K, Godersky JC, Gentry L. Pseudoaneurysm of the extracranial vertebral artery. J Neurosurg 1987,67:935-939.

[11] 11. de Villiers JC, Grant AR. Stab wounds at the craniocervical junction. Neurosurgery 1985; 17:930-936.

[12] 12. Dragon R, Saranchak H, Lakin P, Strauch G. Blunt injuries to the carotid and vertebral arteries. Am J Surg 1981; 141:497-500.

[13] 13. Drake CG. Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg 1975;43:255-274.

[14] 14. Early CB, Shuring AG, Hunt WE. False aneurysm of the vertebral artery: a complication of radon seed implantion. Ann Surg 1966;164:900-904.

[15] 15. Edwards A. Ehlers-Danlos syndrome with vertebral artery aneurysm. Proc R Soc Med 1969;62:14-15.

[16] 16. Farley HH, Nixon R, Peterson TA, Hitchcock CR. Penetrating wounds of the neck. Am J Surg 1964;108:592-596.

[17] 17. Fedele FA, Ho G, Dorman BA. Pseudoaneurysm of the vertebral artery: a complication of rheumatoid cervical spine disease. Arthritis Rheum 1986;29:136-141.

[18] 18. Golueke P, Sclafani S, Phillips T, Goldstein A, Scalea T, Duncan A. Vertebral artery injury: diagnosis and management. J Trauma 1987;27:856-865,

[19] 19. Hadley MN, Spetzler RF, Masferrer R, Martin NA, Carter LP. Occipital artery to extradural vertebral artery bypass procedure. J Neurosurg 1985;63:622-625,

[20] 20. Hanakita J, Suwa H, Nishihara K, lihara K, Sakaida H. Giant pseudoaneurysm of the extracranial vertebral artery sucessfully treated using intraoperative balloon catheters. Neurosurgery 1991;28:738-741.

[21] 21. Hatzitheofilou C, Demetriades D, Melissas J, Stewart M, Franklin J. Surgical approaches to vertebral artery injuries. Br J Surg 1988;75:234-237.

[22] 22. Hayes P, Gerlock AJ Jr, Cobb CA. Cervical spine trauma: a cause of vertebral artery injury. J Trauma 1980,20:904-905.

[23] 23. Heilbrun MP, Ratcheson RA. Multiple extracranial vessel injuries following closed head and neck traumaJ Neurosurg 1972;37:219-223.

[24] 24. Heifetz CJ. Traumatic aneurysm of the first portion of the left vertebral artery. Ann Surg 1945; 122:102-110.

[25] 25. Heros RC. Cerebellar infarction resulting from traumatic occlusion of a vertebral artery. J Neurosurg 1979;51:111-113.

[26] 26. Higashida RT, Halbach VV, Tsai FY, Norman D, Pribram HF, Mehringer CM, Hieshima GB. Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases. AIR 1989; 153:577-582.

[27] 27. Hilton-Jones D, Warlow CP: Non-penetrating arterial trauma and cerebral infarction in the young. Lancet 1985; 1:1435-1438.

[28] 28. Kanshepolsky J, Danielson H, Flynn RE. Vertebral artery insufficiency and cerebellar infarct due to manipulation of the neck: report of a case. Bull Los Angeles Neurol Soc 1972;37:62-66.

[29] 29. Katirji MB, Reinmuth OM, Latchaw RE. Stroke due to vertebral artery injury. Arch Neurol 1985;42:242-248.

[30] 30. Kister SJ, Rankow RM: Traumatic aneurysm of the first portion of the left vertebral artery. Plast Reconstr Surg 1966;37:546-549.

[31] 31. Krueger BR, Okazaki H. Vertebral-basilar distribution infarction following chiropratic cervical manipulation. Mayo Clin Proc 1980;55:322-332.

[32] 32. Matas R. Traumatisms and traumatic aneurysms of the vertebral artery and their surgical treatment, with report of a cured case. Ann Surg 1893;18:477-521.

[33] 33. McLean JM, Wright RM, Henderson JP, Lister JR. Vertebral artery rupture associated with closed head injury. J Neurosurgl985;62:135-138.

[34] 34. Mehalic T, Farhat SM. Vertebral artery injury from chiropratic manipulation of the neck. Surg Neurol 1974;2:125-129.

[35] 35. Meier DE, Brink BE, Fry WJ. Vertebral artery trauma. Arch Surgl981 ;116:236-239.

[36] 36. O'Connel JD, Sutton D, Kendall B. Traumatic vertebral artery aneurysm: report of two cases. Br J Radiol 1975,48:670-673.

[37] 37. Okawara S, Nibbelink D. Vertebral artery occlusion following hyperextension and rotation of the head. Stroke 1974;5:640-642,

[38] 38. Rahimizadeb A, Sabouri-Daylami M, Amir-Moezi N, Haddadian K. Traumatic aneurysm of the extracranial vertebral artery. Neurosurgery 1986;19:628-630.

[39] 39. Raskind R, North C. Vertebral artery injuries following chiropratic cervical spine manipulation. Angiology 1990;41:445-452.

[40] 40. Reid JDS, Weigelt JA. Forty-three cases of vertebral artery trauma. J Trauma 1988;28:1007-1012.

[41] 41. Rich NM, Spencer FC. Carotid and vertebral artery injuries, In Rich NM, Spence FC. Vascular Trauma. Philadelphia: WB Saunders, I978;260-286.

[42] 42. Roper PR, Guinto FC, Wolma FJ: Posttraumatic vertebral artery aneurysm and arteriovenous fistula: a case report. Surgery 1984;96:556-559,

[43] 43. Ross DA, Olsen WL, Halbach V, Rosegay H, Pitts LH. Cervical root compression by a traumatic pseudoaneurysm of the vertebral artery. Neurosurgery 1988;22:414-417,

[44] 44. Schellhas KP, Latchaw RE, Wendling LR, Gold LHA. Vertebro-basilar injuries following cervical manipulations. JAMA 1980;244:1450-1453

[45] 45. Sherman DG, Hart RG, Easton JD. Abrupt changes in head position and cerebral infarction. Stroke 1981; I2:2-6.

[46] 46. Shintani A, Zervas NT. Consequence of ligation of the vertebral artery. J Neurosurg 1972;36:447-450.

[47] 47. Schubiger O, Yasargil MG: Extracranial vertebral aneurysm with neurofibromatosis. Neuroradiology 1978; 15:171 -173.

[48] 48. Simeone FA, Goldberg HI. Thrombosis of the vertebral artery from hyperextension injury to the neck. J Neurosurg 1968;29:540-544.

[49] 49. Thomas GI, Anderson KN, Hain RF, Merendino KA: The significance of anomalous vertebral-basilar artery communications in operations on the heart and great vessels: an illustrative case with review of the literature. Surgery 1959;46:747-757.

[50] 50. Thompson JE, Eilber F, Baker JD. Vertebral artery aneurysm. Surgery 1979;85:583-585.

[51] 51. Wiener I, Flye M W. Traumatic false aneurysm of the vertebral artery. J Trauma 1984;24:346-349.

[52] 52. Willis BK, Greiner F, Orrison WW, Benzei EC: The incidence of vertebral artery injury after midcervical spine fracture or subluxation.Neurosurgery 1994;34:435-441.

[53] 53. Yates PO. Birth trauma to the vertebral arteries. Arch Dis Child 1959;34:436-441.