title: Treatment of a partially thrombosed giant aneurysm of the vertebral artery by aneurysm trapping and direct vertebral artery-posterior inferior cerebellar artery end-to-end anastomosis: technical case report.
abstract: OBJECTIVE
  The purpose of this article is to focus for the first time on the operative management of a direct vertebral artery (VA)-posterior inferior cerebellar artery (PICA) end-to-end anastomosis in a partially thrombosed giant VA-PICA-complex aneurysm and to underline its usefulness as an additional treatment option.
  
  
  METHODS
  The operative technique of a direct VA-PICA end-to-end anatomosis is described in detail. The VA was entering the large aneurysm sack. Distally, the PICA originated from the aneurysm sack-VA-complex. The donor and recipient vessel were cut close to the aneurysm. Whereas the VA was cut in a straight manner, the PICA was cut at an oblique 45-degree angle to enlarge the vascular end diameter. Vessel ends were flushed with heparinized saline and sutured. The thrombotic material inside the aneurysm sack was removed and the distal VA clipped, leaving the anterior spinal artery and brainstem perforators free.
  
  
  RESULTS
  The patient regained consciousness without additional morbidity. Magnetic resonance imaging scans revealed a completely decompressed brainstem without infarction. The postoperative angiograms demonstrated a good filling of the anastomosed PICA.
  
  
  CONCLUSIONS
  Despite the caliber mistmatch of these two vessels the direct VA-PICA end-to-end anastomosis provides an accurate alternative in addition to other anastomoses and bypass techniques, when donor and recipient vessels are suitable and medullary perforators do not have to be disrupted.
authors.affiliation: Department of Neurosurgery, Philipps University Medical Center, Marburg, Germany. benes@med.uni-marburg.de
authors.forename: Ludwig
authors.initials: L
authors.lastname: Benes
authors.forename: Christoph
authors.initials: C
authors.lastname: Kappus
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.forename: Helmut
authors.initials: H
authors.lastname: Bertalanffy
mesh_terms: D000368:Aged; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D002531:Cerebellum / Q000098:blood supply; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D003391:Cranial Nerves / Q000033:anatomy & histology / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods*; D009777:Occipital Bone / Q000473:pathology / Q000601:surgery; D019736:Prostheses and Implants / Q000592:standards; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*