title: Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion.
abstract: BACKGROUND
  In patients with aneurysms that involve the origin of the posterior inferior cerebellar artery (PICA) and require occlusion of the vertebral artery (VA), revascularization of the PICA is commonly performed. We present six patients with dissecting VA aneurysms who underwent PICA-PICA anastomosis combined with parent artery occlusion.
  
  
  METHODS
  After a lower lateral suboccipital craniectomy and partial resection of the jugular tubercle, anastomoses were performed in a side-to-side fashion at the posterior medullary segment of the PICA. The VA was subsequently occluded by clipping proximal and distal to the aneurysm, and the PICA was occluded by clipping distal to the aneurysm.
  
  
  RESULTS
  Postoperative cerebral angiography demonstrated patency of the anastomosis and regression of the aneurysm in five of six patients. The remaining patient experienced hemorrhage from contralateral VA dissection and subsequently died. One patient experienced myopathy of the lower extremities secondary to intraoperative fixed board compression and developed permanent lower extremity muscular weakness. The remaining four cases experienced no new neurologic deficits.
  
  
  CONCLUSIONS
  PICA-PICA anastomosis is a useful procedure for reconstruction of the PICA when parent vessel occlusion or trapping is necessary to exclude a VA aneurysm involving the origin of the PICA.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kakino
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Otawara
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tomizuka
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D014854:Lateral Medullary Syndrome / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019635:Neurosurgical Procedures / Q000379:methods; D011182:Postoperative Care; D014711:Vertebral Artery