Aneurysm trapping by both direct and endovascular surgery for vertebral artery dissection: A case report

BACKGROUND: Although vertebral artery (VA) dissecting aneurysms are treated by direct or endovascular surgery, some disadvantages are associated with each surgery. Therefore, the type of surgery should be selected based on the condition of the aneurysm. We performed aneurysm trapping by endovascular surgery via the contralateral VA after proximal direct ligation with bypass to prevent complications as well as achieve complete treatment. CASE DESCRIPTION: We attempted to insert a distal clip to achieve complete trapping of the ruptured VA dissecting aneurysm after proximal ligation with occipital artery-posterior inferior cerebellar artery (PICA) anastomosis; however, the operative field was limited by the existence of lower cranial nerves, brain swelling, and tortuosity of VA. Therefore, we performed the aneurysmal trapping by endovascular surgery via contralateral VA just after the direct surgery. CONCLUSIONS: This technique can provide complete resolution without any complications, particular in the case of bleeding VA dissecting aneurysms that have a PICA origin and are located in the high or contralateral position.