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Primary Extracranial Vertebral Artery Aneurysms: A Case Series
Sachin V. Phade, MD1, Mark D. Morasch, MD2, Justin Hurie, MD3, Peter A. Naughton, MD4, Manuel Garcia-Toca, MD2, Ramon Berguer, MD3.
1Northwestern Unversity, Chicago, IL, USA, 2Northwestern University, Chicago, IL, USA, 3University of Michigan, Ann Arbor, MI, USA, 4St. James Hospital, Dublin, Ireland.

Objective:
Extracranial vertebral artery aneurysms are uncommon and are usually associated with trauma or dissection. Primary cervical vertebral aneurysms are even rarer and are not well described. The presentation and natural history are unknown and operative management can be difficult. Accessing aneurysms at the skull base can be taxing, and since the frail arteries are often afflicted with connective tissue abnormalities, direct repair can be particularly challenging. We describe the presentation and surgical management of patients with primary extracranial vertebral artery aneurysms.
Methods:
A retrospective multi-institutional review of patients with primary aneurysms within the extracranial vertebral artery.
Results:
Between January 1, 2000, and December 3, 2010, 7 patients, age 12-56, were noted to have 9 primary extracranial vertebral artery aneurysms. All had underlying connective tissue or other hereditary disorder including Ehler-Danlos (3), Marfan’s (2), neurofibromatosis (1) and an unspecified connective tissue abnormality (1). Seven aneurysms were managed operatively, including one attempted bypass that ultimately required vertebral ligation; the contralateral aneurysm on this patient has not been treated. Open interventions included vertebral bypass with vein, external carotid autograft, and vertebral transposition to the internal carotid artery. Special techniques were used for handling the anastomoses in patients with Ehler-Danlos. While endovascular exclusion was not performed in isolation, two hybrid procedures were performed. There were no perioperative strokes or deaths.
Conclusions:
Primary extracranial vertebral artery aneurysms are rare and occur in patients with hereditary disorders. Operative intervention is warranted in symptomatic patients. Exclusion and reconstruction may be performed with open and hybrid techniques with low morbidity and mortality.


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