title: Occipital artery-to-posterior inferior cerebellar artery anastomosis with multiple-layer dissection of suboccipital muscles under a reverse C-shaped skin incision.
abstract: Although occipital artery (OA)-to-posterior inferior cerebellar artery (PICA) anastomosis is the most familiar reconstruction for posterior cerebral circulation, the procedure is considered difficult because of the anatomical complex course of OA and the depth of the operative field at the anastomosis site. Therefore, we attempted a safe and reliable method for OA-to-PICA anastomosis under multiple-layer dissection of suboccipital muscles and a reverse C-shaped skin incision. We reviewed the clinical records of patients who underwent OA-to-PICA anastomosis in our institute, and report the outcome with special emphasis on graft patency and surgical complications. Nine patients are described. In one patient the bypass was accomplished at the cortical segment of the PICA and in all others at the caudal loop. The average time for de-clamping the PICA was 29 min and 29 s. Although the overall graft patency rate was 100%, one patient showed a new medulla infarction at the time of post-operatory three-dimensional computed tomography angiography. Besides a secure OA-to-PICA anastomosis, this technique allows safe harvest of the OA and the creation of a shallow and wide anastomosis field.
authors: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital , Abashiri, Hokkaido , Japan.
authors: Makoto
authors: M
authors: Katsuno
authors: Rokuya
authors: R
authors: Tanikawa
authors: Genki
authors: G
authors: Uemori
authors: Kazutsune
authors: K
authors: Kawasaki
authors: Naoto
authors: N
authors: Izumi
authors: Masaaki
authors: M
authors: Hashimoto
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002536:Cerebral Arteries / Q000601:surgery*; D005260:Female; D006257:Head / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D019635:Neurosurgical Procedures; D014711:Vertebral Artery / Q000601:surgery*
keywords: bypass; occipital artery; posterior circulation; posterior inferior cerebellar artery; suboccipital muscle