Vertebral artery-posterior inferior cerebellar artery bypass with a superficial temporal artery graft to treat aneurysms involving the posterior inferior cerebellar artery.
OBJECTIVE
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.
Hamada
Jun-ichiro
J
Department of Neurosurgery, Kumamoto University School of Medicine, Japan. j-hamada@fc.kuh.kumamoto-u.ac.jp
Todaka
Tatemi
T
Yano
Shigetoshi
S
Kai
Yutaka
Y
Morioka
Motohiro
M
Ushio
Yukitaka
Y
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001933:Brain Stem / Q000098:blood supply; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D014854:Lateral Medullary Syndrome / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000601:surgery; D013699:Temporal Arteries / Q000637:transplantation*; D014711:Vertebral Artery / Q000601:surgery*