[Cerebral dissecting aneurysms].

INTRODUCTION: Blood stream penetrates through the lacerations of the arterial layers determining dissecting aneurysms. Each intramural clot localization determines different clinical form.

OBJECTIVE: We present the clinical observations carried out in two patients with vertebrobasilar dissecting aneurysms and we review the state of the art of this process to remark the early identification of these unusual lesions.

CASE REPORTS: Two cases of vertebrobasilar dissecting aneurysms were described. They were young patients that debuted, one as posteroinferior artery brain steam infarction and the other one as a subarachnoid hemorrhage caused by a right posterior cerebral artery dissecting aneurysms. Lesions were confirmed by helicoidal cerebral angiotomographic and angiograms. This patient was operated on and we clipped the posterior communicating that irrigated dissecting segment. We carry out an anatomical and hemodynamic analysis of that lesion. Both patients had a satisfactory clinical evolution.

CONCLUSIONS: Dissecting intramural hematomas of the vertebrobasilar territory are frequent cause of young people ictus. It has been suggested that the ictus may happen after minor head trauma and pain, main symptom, always precedes neurological dysfunction signs. Hemorrhagic presentation has a high incidence of rebleeding and elevated mortality. It always requires, as soon as possible, direct microsurgical treatment or endovascular methods (coils). Most useful microsurgical procedure, until today, is parent artery clipping. This technique has a low index of isquemic and neural postoperative damage.