title: Bypass Revascularization Applied to the Posterior Cerebral Artery.
abstract: BACKGROUND
  The application of bypass procedures to the posterior cerebral artery (PCA) in combination with proximal clipping or trapping is a useful option for the treatment of complex posterior circulation aneurysms, especially those of the PCA. Because of its course around the midbrain through various cisterns, different approaches are required to access the PCA.
  
  
  OBJECTIVE
  The presented study analyzes a retrospective case series of bypass procedures to the PCA to investigate the relevant treatment strategies and their outcomes.
  
  
  METHODS
  Seven patients with bypass procedures to the PCA bypass were analyzed. The location of the aneurysms, approaches, site of anastomosis, bypass patency, pre- and postoperative modified Rankin Scale scores, and transient and permanent morbidity were assessed.
  
  
  RESULTS
  Analyzed patients were treated for intracranial aneurysm located on the P2 (n = 3) or P3 (n = 2) of the PCA, bilateral vertebral artery dissecting aneurysm (n = 1) or internal carotid artery-posterior communicating artery aneurysm (n = 1). The following approaches were used: anterior temporal approach (n = 2), anterior temporal approach combined with subtemporal approach (n = 2), combined transpetrosal approach (n = 1), posterior interhemispheric approach (n = 1), and posterior interhemispheric approach with subtemporal approach (n = 1). All bypasses were patent. Permanent morbidity occurred in 2 patients via cognitive dysfunction (n = 1) and hemiparesis (n = 1).
  
  
  CONCLUSIONS
  Bypass revascularization of the PCA territory is effective for the treatment of complex vascular lesions affecting the posterior circulation. To address the various surgical segments of the PCA, different approaches are required. Combined approaches allow access to the PCA proximal and distal from the lesion.
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Goehre
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kinoshita
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Matsukawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yanagisawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Sakakibara
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
authors.affiliation: Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Kyousuke
authors.initials: K
authors.lastname: Kamada
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan. Electronic address: taniroku@gmail.com.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
mesh_terms: D000328:Adult; D000368:Aged; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aneurysm; Anterior temporal approach; Bypass; Combined transpetrosal approach; Posterior cerebral artery; Posterior interhemispheric approach