scholarly journals Occipital Artery to Anterior Inferior Cerebellar Artery Bypass with Radial Artery Interposition Graft for Vertebrobasilar Insufficiency: 3-Dimensional Operative Video

2017 ◽  
Vol 13 (5) ◽  
pp. 641-641 ◽  
Author(s):  
Arnau Benet ◽  
Halima Tabani ◽  
Jae Seung Bang ◽  
Ali Tayebi Meybodi ◽  
Michael T. Lawton
Keyword(s):  
Radial Artery ◽  
Artery Bypass ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Vertebrobasilar Insufficiency ◽  
3 Dimensional ◽  
Interposition Graft ◽  
Cerebellar Artery

Vertebral artery–posterior inferior cerebellar artery bypass using a radial artery graft for hemorrhagic dissecting vertebral artery aneurysms: surgical technique and report of 2 cases

2011 ◽  
Vol 114 (4) ◽  
pp. 1074-1079 ◽  
Author(s):  
Marcus Czabanka ◽  
Muhammad Ali ◽  
Peter Schmiedek ◽  
Peter Vajkoczy ◽  
Michael T. Lawton
Keyword(s):  
Vertebral Artery ◽  
Radial Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Radial Artery Graft ◽  
Interposition Graft ◽  
Endovascular Occlusion ◽  
Artery Graft ◽  
Cerebellar Artery ◽  
Far Lateral Approach

Endovascular occlusion of hemorrhagic dissecting aneurysms of the vertebral artery (VA) is not possible when the posterior inferior cerebellar artery (PICA) originates from the dissecting aneurysm or when the contralateral VA provides inadequate collateral blood flow to the distal basilar circulation. The authors introduce a VA-PICA bypass with radial artery interposition graft and aneurysm trapping as an alternative approach and describe 2 cases in which this bypass was used to treat hemorrhagic dissecting VA aneurysms. The VA-PICA bypass is performed via a standard far lateral approach. An end-to-side anastomosis between the radial artery graft and the PICA at the level of the caudal loop is performed first, and an end-to-side anastomosis is performed between the V3 segment and the proximal end of the radial artery graft. A 56-year-old woman harbored a hemorrhagic dissecting VA aneurysm incorporating the origin of the PICA. Endovascular treatment failed, with aneurysm refilling on follow-up angiography. A 65-year-old man had a hemorrhagic dissecting VA aneurysm and a hypoplastic contralateral VA. Both patients were treated with the VA-PICA bypass and aneurysm trapping, with adequate filling of the PICA territory in the first patient and both the PICA territory and the basilar circulation in the second patient. Vertebral artery–PICA bypass with radial artery interposition graft and subsequent trapping of the dissected VA segment is an alternative to occipital artery–PICA and PICA-PICA bypass for the treatment of hemorrhagic dissecting VA aneurysms that are not suitable for endovascular occlusion.

An a3-Anterior Inferior Cerebellar Artery to p3-Posterior Inferior Cerebellar Artery Bypass With Thrombectomy and Trapping of an Anterior Inferior Cerebellar Artery Aneurysm: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E311-E312
Author(s):  
Justin R Mascitelli ◽  
Sirin Gandhi ◽  
Jacob F Baranoski ◽  
Michael J Lang ◽  
Michael T Lawton
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Artery Aneurysm ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Retrograde Filling ◽  
In Situ Bypass

Abstract In situ bypasses to the anterior inferior cerebellar artery (AICA) are unusual because, with only one artery in the cerebellopontine angle (CPA), no natural intracranial donors parallel its course. In rare cases, the posterior inferior cerebellar artery (PICA) may have the tortuosity or redundancy to be mobilized to the AICA to serve as a donor. This video demonstrates this p3 PICA-to-a3 AICA in situ side-to-side bypass. A 75-yr-old woman presented with ataxia and hemiparesis from a large thrombotic right AICA aneurysm compressing the brainstem. Strategy consisted of bypass, trapping, and brainstem decompression. Written informed consent for surgery was obtained from the patient. A hockey-stick incision was made to harvest the occipital artery as a backup donor, but its diminutive caliber precluded its use. The bypass was performed through an extended retrosigmoid craniotomy. The aneurysm was trapped completely and thrombectomized to relieve the pontine mass effect. Indocyanine green videoangiography confirmed patency of the bypass, retrograde filling of the AICA to supply pontine perforators, and no residual aneurysmal filling. This unusual in situ bypass is possible when redundancy of the AICA and PICA allow their approximation in the CPA. The anastomosis is performed lateral to the lower cranial nerves in a relatively open and superficial plane. The extended retrosigmoid approach provides adequate exposure for both the bypass and aneurysm trapping. In situ AICA-PICA bypass enables anterograde and retrograde AICA revascularization with side-to-side anastomosis. The occipital artery-to-AICA bypass and the V3 vertebral artery-to-AICA interpositional bypass are alternatives when intracranial anatomy is unfavorable for this in situ bypass.1–6 Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Microsurgical Reconstruction of the Posterior Circulation

1984 ◽  
Vol 92 (1) ◽  
pp. 102-108 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Vertebrobasilar Insufficiency ◽  
Surgical Morbidity ◽  
Microsurgical Reconstruction ◽  
Cerebellar Artery ◽  
Vertebrobasilar Junction

Thirty-four patients with vertebrobasilar Insufficiency (VBI) were evaluated between 1974 and 1982. Twenty-two presented with transient VBI and 12 with residual strokes. The frequency of preoperative symptoms varied from once or twice a month to multiple daily events. Four patients with high-grade vertebral stenosis were treated by local vertebral endarterectomy at the C1 level. Seven patients underwent an anastomosis of the occipital artery to the posterior inferior cerebellar artery for distal vertebral basilar junction stenosis or occlusion. Three patients underwent anastomosis of the occipital artery to the anterior inferior cerebellar artery for vertebral basilar junction occlusion. Twenty patients underwent anastomosis of the superficial temporal to the superior cerebellar artery for distal vertebrobasilar junction stenosis or occlusion or midbasilar occlusive lesions. In 26 of 27 patients (95%), the anastomoses were patent. Two patients died, one from congestive heart failure and one from a brain stem infarct. Immediate complications included meningitis, CSF leaks, temporal lobe swelling, and seizures. Although the early surgical morbidity is high, it is only transient. Twenty-six patients have had complete resolution of their symptoms, and three have minor residual dizziness. Long-term morbidity has been limited to a patient with residual Wallenberg's syndrome secondary to the surgical occlusion of the vertebral artery, a patient who remained in a locked-in syndrome as before surgery, and a patient who developed Brown-Séquard syndrome. No further VBI symptoms occurred in one patient who died 4 years after surgery of a myocardial infarction. We believe the surgical approach to the vertebrobasilar area is feasible and can lead to the ultimate recovery of most patients.

OCCIPITAL ARTERY-TO-POSTERIOR INFERIOR CEREBELLAR ARTERY BYPASS FOR TREATMENT OF BILATERAL VERTEBRAL ARTERY OCCLUSION: THE ROLE OF QUANTITATIVE MAGNETIC RESONANCE ANGIOGRAPHY NONINVASIVE OPTIMAL VESSEL ANALYSIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. E779-E781 ◽  
Author(s):  
Robert M. Starke ◽  
Mark Chwajol ◽  
Daniel Lefton ◽  
Chandranath Sen ◽  
Alejandro Berenstein ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Occipital Artery ◽  
Vertebrobasilar Insufficiency ◽  
Vertebral Arteries ◽  
Vertebral Artery Occlusion ◽  
Cerebellar Artery

Abstract OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present with signs and symptoms of transient ischemic attacks or infarction. Advances in phase contrast magnetic resonance imaging have led to noninvasive assessment of volumetric blood flow rates and direction that help in the workup and management of these patients. CLINICAL PRESENTATION We present the case of a patient with symptoms of vertebrobasilar insufficiency without previous transient ischemic attacks or stroke. Quantitative magnetic resonance angiography (QMRA) demonstrated bilateral vertebral artery occlusion with reversal of flow in the basilar and vertebral arteries to the level of the posterior inferior cerebellar arteries bilaterally. A prominent right posterior communicating artery filled the basilar artery and proximal vertebral arteries. INTERVENTION The presence of reversal and diminished flow in the basilar and vertebral arteries suggested that occipital artery-to-posterior inferior cerebellar artery bypass would improve posterior circulation, relieve symptoms, and reduce the risk of infarction. Postoperative QMRA and angiography confirmed revascularization, and QMRA confirmed correction of blood flow direction. CONCLUSION This case illustrates the potential of QMRA as part of a comprehensive cerebrovascular assessment, operative planning, and follow-up of patients with vertebrobasilar insufficiency.

Treatment of an Anterior Inferior Cerebellar Artery Aneurysm With Microsurgical Trapping and In Situ Posterior Inferior Cerebellar Artery to Anterior Inferior Cerebellar Artery Bypass: Case Report

2017 ◽  
Vol 15 (4) ◽  
pp. 418-424 ◽  
Author(s):  
Bryan S Lee ◽  
Alex M Witek ◽  
Nina Z Moore ◽  
Mark D Bain
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Significant Risk ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Vessel ◽  
Cerebellar Artery ◽  
Far Lateral Approach

Abstract BACKGROUND Anterior inferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment can involve microsurgical and/or endovascular techniques. Such treatment can be challenging and may carry a significant risk of neurological morbidity. OBJECTIVE To demonstrate a case involving a complex AICA aneurysm that was treated with a unique microsurgical approach involving trapping the aneurysm and performing in Situ bypass from the posterior inferior cerebellar artery (PICA) to the distal AICA. The nuances of AICA aneurysms and revascularization strategies are discussed. METHODS The aneurysm and the distal segments of AICA and PICA were exposed with a retrosigmoid and far lateral approach. A side-to-side anastomosis was performed between the adjacent caudal loops of PICA and AICA. The AICA aneurysm was then treated by trapping the aneurysm-bearing segment of the parent vessel between 2 clips. RESULTS A postoperative angiogram demonstrated a patent PICA-AICA bypass and complete occlusion of the AICA aneurysm. There were no complications, and the patient made an excellent recovery. CONCLUSION The combination of parent vessel sacrifice and bypass remains an excellent option for certain difficult-to-treat aneurysms. This case involving PICA-AICA bypass to treat an AICA aneurysm serves as an example of the neurosurgeon's ability to develop unique solutions that take advantage of individual anatomy.

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