title: Superior cerebellar artery-posterior cerebral artery bypass: in situ bypass for posterior cerebral artery revascularization.
abstract: Iatrogenic pseudoaneurysms are rare but serious complications of transsphenoidal surgery, and an iatrogenic pseudoaneurysm of the posterior cerebral artery (PCA) has been reported just once in the literature. The authors encountered such a case with a new P1 segment PCA pseudoaneurysm after endoscopic transsphenoidal resection of a pituitary adenoma. The aneurysm proved ideal for a novel intracranial-intracranial bypass in which the superior cerebellar artery (SCA) was used as an in situ donor artery to revascularize the recipient P2 segment. The bypass allowed aneurysm trapping without causing ischemic stroke or neurological morbidity. This case represents the first reported surgical treatment of an iatrogenic PCA pseudoaneurysm. Endovascular occlusion with coils was an option, but dolichoectatic morphology requires sacrifice of the P1 segment, with associated risks to the thalamoperforators and circumflex perforators. The SCA-PCA bypass was ideal because of low-flow demands. Like other in situ bypasses, it requires no dissection of extracranial arteries, no second incision for harvesting interposition grafts, and has a high likelihood of long-term patency. The SCA-PCA bypass is also applicable to fusiform SCA aneurysms requiring revascularization with trapping. This case demonstrates a dangerous complication that results from the limited view of the posterolateral surgical field through the endoscope and the imprecision of endoscopic instruments.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Hernández
authors.forename: Christina
authors.initials: C
authors.lastname: Huang
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010911:Pituitary Neoplasms / Q000601:surgery; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome