title: Vertebral artery-to-vertebral artery bypass with interposed radial artery or occipital artery grafts: surgical technique and report of three cases.
abstract: BACKGROUND
  The treatment of unclippable vertebral artery (VA) aneurysms incorporating the posterior inferior cerebellar artery with parent artery preservation is among one of the most formidable challenges for cerebrovascular microsurgery and endovascular surgery. We propose that intracranial VA reconstruction using an extracranial VA-to-intracranial VA (VA-VA) bypass with a radial artery graft or an occipital artery graft may be an additional technique in the armamentarium to treat these formidable lesions. The rationale, surgical technique, and complications are discussed.
  
  
  METHODS
  Three illustrative cases are described, in which the lesions were a VA dissecting aneurysm with ischemic lesions, bilateral asymptomatic unruptured VA aneurysms, and a VA giant aneurysm with subarachnoid hemorrhage.
  
  
  RESULTS
  The partial extreme lateral infrajugular transcondylar approach was used. Computed tomographic angiography was useful for preoperative evaluation of the depth of the distal aneurysmal neck. A VA-VA bypass was performed in two patients. Because there was another ipsilateral aneurysm at the V2 segment in one patient, an external carotid artery-VA bypass was performed. Although two patients were discharged with good clinical results, one patient with subarachnoid hemorrhage died because of brainstem infarction.
  
  
  CONCLUSIONS
  The VA-VA bypass using a radial artery graft or an occipital artery graft is an option that can be considered in the strategy for treating VA aneurysms to preserve the normal anatomic vascular configuration in the posterior circulation.
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Hisashi
authors: H
authors: Kubota
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan. Electronic address: taniroku@gmail.com.
authors: Rokuya
authors: R
authors: Tanikawa
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Makoto
authors: M
authors: Katsuno
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Naoto
authors: N
authors: Izumi
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Kosumo
authors: K
authors: Noda
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Nakao
authors: N
authors: Ota
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Yohei
authors: Y
authors: Ishishita
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Takanori
authors: T
authors: Miyazaki
authors: Department of Neurosurgery, Seirei Memorial Hospital, Ibaraki, Japan.
authors: Shinichi
authors: S
authors: Okabe
authors: Department of Neurosurgery, Yokohama Shin-midori General Hospital, Kanagawa, Japan.
authors: Sumio
authors: S
authors: Endo
authors: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors: Mika
authors: M
authors: Niemelä
authors: Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
authors: Masaaki
authors: M
authors: Hashimoto
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000601:surgery* / Q000637:transplantation; D057510:Endovascular Procedures; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology / Q000601:surgery; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D017534:Radial Artery / Q000601:surgery* / Q000637:transplantation; D012308:Risk Management; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000601:surgery* / Q000637:transplantation
keywords: Everting technique; Intracranial vertebral artery reconstruction; Occipital artery graft; Radial artery graft; Vertebral artery-to-vertebral artery bypass