• Nithipat Durongwatana, Kitiporn Sriamornrattanakul, Somkiat Wongsuriyanan, and Nasaeng Akharathammachote.
• Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
• World Neurosurg. 2022 Mar 1; 159: e375-e388.

BackgroundVertebral artery dissection (VAD) is a rare cerebrovascular disease that can lead to permanent morbidity or mortality. Open surgery for VAD is challenging; therefore, most cases are managed via endovascular techniques. There are several surgical methods for VAD treatment, including trapping or proximal occlusion with or without bypass; however, the standard treatment protocol is not well established. The aims of this study were to demonstrate surgical strategies, surgical outcomes, and complications of each method and to propose an algorithm to select the appropriate procedure.MethodsThis study included 22 patients with VAD who underwent open surgical treatment between January 2015 and December 2019 and were retrospectively reviewed and evaluated for postoperative outcomes and complications.ResultsProximal occlusion, trapping, occipital artery-posterior inferior cerebellar artery (PICA) bypass with blind-alley formation, and occipital artery-PICA with trapping were performed in 13, 2, 5, and 2 patients. The surgical procedure depended on the type of VAD: pre-PICA, PICA, post-PICA, and non-PICA. All VADs were completely obliterated after surgery. Obliteration occurred immediately for 18 patients (81.8%) and within 1 week for 4 patients (18.2%). There was no postoperative bleeding or PICA infarction. Favorable outcome at 3 months after operation was achieved in 100% for good-grade patients and 86.4% overall.ConclusionsOpen surgery can be a safe and effective treatment of VAD when surgical strategies are carefully selected. Angioarchitecture and the type of VAD influence the selection of the surgical method.Copyright © 2021 Elsevier Inc. All rights reserved.

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