Vertebral artery—posterior inferior cerebellar artery bypass with a superficial temporal artery graft to treat aneurysms involving the posterior inferior cerebellar artery

Restricted access

Object. In patients with aneurysms that require occlusion of the posterior inferior cerebellar artery (PICA), revascularization of this artery should be performed. A novel surgical method for revascularization of the PICA is presented.

Methods. After a segment of the superficial temporal artery (STA) was harvested, the aneurysm was treated by trapping, followed by placement of a vertebral artery (VA)—PICA bypass in which the STA segment was used as a graft. When the length of the proximal PICA was inadequate, the distal end of the STA was anastomosed to the proximal PICA in an end-to-side fashion. When the length of the proximal PICA was adequate, the STA was anastomosed to the proximal PICA in an end-to-end fashion. In either case, the proximal end of the STA was anastomosed to the VA in an end-to-side fashion. This procedure was used in nine patients whose aneurysms involved the PICA. Although partial lateral medullary syndrome developed in one of them, follow-up evaluation revealed graft patency in all patients. There were no instances of recurrent hemorrhage or ischemia.

Conclusions. Although this procedure requires harvesting of an STA graft and two anastomoses, it facilitates anterograde flow to the PICA territory. It also involves minimal mobilization of brainstem perforating vessels and the proximal PICA.

Article Information

Address reprint requests to: Jun-ichiro Hamada, M.D., Department of Neurosurgery, Kumamoto University School of Medicine, 1–1–1 Honjo, Kumamoto 860–856, Japan. email: j-hamada@fc.kuh.kumamoto-u.ac.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 3. Lateral view of a preoperative left VA angiogram revealing a fusiform dilation of the left PICA at its origin from the VA (arrow).

  • View in gallery

    Case 3. Intraoperative photograph obtained after the VA—PICA bypass in which an STA graft (arrowheads) was used. The brainstem perforating vessel (small arrows) is patent. Large arrows indicate suture lines.

  • View in gallery

    Case 3. Lateral view of a postoperative left VA angiogram demonstrating a patent anastomosis of the PICA to the VA with an interposed STA graft (arrowheads). Arrows indicate Sugita clips.

  • View in gallery

    Case 8. Lateral view of a preoperative right VA angiogram revealing a dissecting aneurysm of the VA (arrow) involving the PICA (arrowheads).

  • View in gallery

    Case 8. Intraoperative photograph obtained after the VA—PICA bypass in which an STA graft (arrowheads) was used. Arrows indicate suture lines and the star indicates the spinal accessory nerve.

  • View in gallery

    Case 8. Lateral view of a postoperative left VA angiogram demonstrating a patent anastomosis of the PICA to the VA with an interposed STA graft (arrowheads). Arrows indicate Sugita clips.

References

  • 1.

    Ausman JIDiaz FGMullan Set al: Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73:4624651990Ausman JI Diaz FG Mullan S et al: Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73:462–465 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Berger MSWilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:8828941984Berger MS Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894 1984

    • Search Google Scholar
    • Export Citation
  • 3.

    Chater N: Microsurgical vascular bypass for occlusive cerebrovascular disease in Rand RW (ed): Microneurosurgeryed 2. St. LouisMosby1978 pp 363378Chater N: Microsurgical vascular bypass for occlusive cerebrovascular disease in Rand RW (ed): Microneurosurgery ed 2. St. Louis Mosby 1978 pp 363–378

    • Search Google Scholar
    • Export Citation
  • 4.

    Durward QJ: Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82:1371391995Durward QJ: Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82:137–139 1995

    • Search Google Scholar
    • Export Citation
  • 5.

    Friedman AHDrake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:3253341984Friedman AH Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334 1984

    • Search Google Scholar
    • Export Citation
  • 6.

    Hamada JNagahiro SMimata Cet al: Reconstruction of the posterior inferior cerebellar artery in the treatment of giant aneurysms. Report of two cases. J Neurosurg 85:4964991996Hamada J Nagahiro S Mimata C et al: Reconstruction of the posterior inferior cerebellar artery in the treatment of giant aneurysms. Report of two cases. J Neurosurg 85:496–499 1996

    • Search Google Scholar
    • Export Citation
  • 7.

    Hunt WEKosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79891974Hunt WE Kosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89 1974

    • Search Google Scholar
    • Export Citation
  • 8.

    Lee KSGower DJBranch CL Jret al: Surgical repair of aneurysms of the posterior inferior cerebellar artery—a clinical series. Surg Neurol 31:85911989Lee KS Gower DJ Branch CL Jr et al: Surgical repair of aneurysms of the posterior inferior cerebellar artery—a clinical series. Surg Neurol 31:85–91 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Marano SRFischer DWGaines Cet al: Anatomical study of the superficial temporal artery. Neurosurgery 16:7867901985Marano SR Fischer DW Gaines C et al: Anatomical study of the superficial temporal artery. Neurosurgery 16:786–790 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Nagashima CIwama KSakata Eet al: Effects of temporary occlusion of a vertebral artery on the human vestibular system. J Neurosurg 33:3883941970Nagashima C Iwama K Sakata E et al: Effects of temporary occlusion of a vertebral artery on the human vestibular system. J Neurosurg 33:388–394 1970

    • Search Google Scholar
    • Export Citation
  • 11.

    Shrontz CDujovny MAusman JIet al: Surgical anatomy of the arteries of the posterior fossa. J Neurosurg 65:5405441986Shrontz C Dujovny M Ausman JI et al: Surgical anatomy of the arteries of the posterior fossa. J Neurosurg 65:540–544 1986

    • Search Google Scholar
    • Export Citation
  • 12.

    Sundt TM JrPiepgras DG: Occipital to posterior inferior cerebellar artery bypass surgery. J Neurosurg 48:9169281978Sundt TM Jr Piepgras DG: Occipital to posterior inferior cerebellar artery bypass surgery. J Neurosurg 48:916–928 1978

    • Search Google Scholar
    • Export Citation
  • 13.

    Yamada KHayakawa TUshio Yet al: Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome. Neurosurgery 15:8348381984Yamada K Hayakawa T Ushio Y et al: Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome. Neurosurgery 15:834–838 1984

    • Search Google Scholar
    • Export Citation
  • 14.

    Yamaura AWatanabe YSaeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:1831881990Yamaura A Watanabe Y Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188 1990

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 53 53 4
Full Text Views 111 86 1
PDF Downloads 106 83 1
EPUB Downloads 0 0 0

PubMed

Google Scholar