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

Jun-ichiro Hamada Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan

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Tatemi Todaka Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan

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Shigetoshi Yano Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan

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Yutaka Kai Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan

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Motohiro Morioka Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan

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Yukitaka Ushio Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan

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Page Range:
867–871
Volume/Issue:
Volume 96: Issue 5
DOI link:
https://doi.org/10.3171/jns.2002.96.5.0867
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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.

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Volume 96: Issue 5

Contributor Notes

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.
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