title: Effectiveness of Intraoperative Indocyanine Green Videoangiography in Avoiding Failure in Proximal Clipping for Dissecting Vertebral Artery Aneurysm Associated with Double Origin of the Posterior Inferior Cerebellar Artery.
abstract: BACKGROUND
  Double origin of the posterior inferior cerebellar artery (PICA) is rarely reported but is associated with cerebral aneurysm and dissection. Such aneurysms and dissections with unusual anatomic dispositions present the surgeon or physician with difficulties during treatment.
  
  
  METHODS
  A 65-year-old man presented with severe subarachnoid hemorrhage caused by a left dissecting VA, which was treated with proximal clipping. No aberrant origin of the PICA was recognized on initial imaging. Dissecting VA was confirmed from mural discoloration and obliterated by clip application proximal to the dissection. However, the dissecting VA that should have been eliminated from the circulation was still depicted on indocyanine green videoangiography. Meticulous inspection revealed an aberrant branch connecting the VA with the PICA. Termination of the dissecting VA was accomplished by division of the aberrant stem of the PICA and was confirmed by indocyanine green videoangiography.
  
  
  CONCLUSIONS
  Despite its rarity, the possibility of a double origin of the PICA should be considered when treating a dissecting VA. Missing a small aberrant origin of the PICA would lead to treatment failure but can be detected by indocyanine green videoangiography during open direct surgery.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Omoto
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan. Electronic address: myasushi@naramed-u.ac.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Motoyama
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shida
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000792:Angiography / Q000379:methods*; D002531:Cerebellum / Q000098:blood supply*; D002536:Cerebral Arteries / Q000002:abnormalities*; D003287:Contrast Media; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D020535:Video-Assisted Surgery / Q000379:methods*
chemical_list: D003287:Contrast Media; D007208:Indocyanine Green
keywords: Dissecting vertebral artery; Double origin of PICA; Indocyanine green