Anastomosis of occipital artery to anterior inferior cerebellar artery with interposition of superficial temporal artery. Case report

1993 ◽  
Vol 40 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Hajime Touho ◽  
Jun Karasawa ◽  
Hideyuki Ohnishi ◽  
Hiroyuki Nakase ◽  
Yasuharu Watabe ◽  
...  
Keyword(s):  
Case Report ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Cerebellar Artery

Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting

1996 ◽  
Vol 85 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Sang Youl Lee ◽  
Laligam N. Sekhar
Keyword(s):  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
First Case ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors report three cases of ruptured, large or giant aneurysms that were treated by excision or trapping, followed by revascularization of distal vessels by means of arterial reimplantation or superficial temporal artery interpositional grafting. In the first case, a large serpentine aneurysm arising from the anterior temporal branch of the right middle cerebral artery (MCA) was excised and the distal segment of the anterior temporal artery was reimplanted into one of the branches of the MCA. In the second case, a giant aneurysm, fusiform in shape, arose from the rolandic branch of the MCA. This aneurysm was totally excised and the M3 branch in which it had been contained was reconstructed with an arterial interpositional graft. In the third case the patient, who presented with a subarachnoid hemorrhage, had a dissecting aneurysm that involved the distal portion of the left vertebral artery. In this case the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm and coursed onward to supply the brainstem. This aneurysm was managed by trapping and the PICA was reimplanted into the ipsilateral large anterior inferior cerebellar artery. None of the patients suffered a postoperative stroke and all recovered to a good or excellent postoperative condition. These techniques allowed complete isolation of the aneurysm from the normal blood circulation and preserved the blood flow through the distal vessel that came out of the aneurysm. These techniques should be considered as alternatives when traditional means of cerebral revascularization are not feasible.

scholarly journals Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction

2019 ◽  
Vol 10 ◽  
pp. 127
Author(s):  
Yuto Hatano ◽  
Nakao Ota ◽  
Kosumo Noda ◽  
Yasuaki Okada ◽  
Yosuke Suzuki ◽  
...  
Keyword(s):  
Anatomic Variation ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Preoperative Ct ◽  
Running Pattern ◽  
Enhanced Computed Tomography ◽  
Artery Reconstruction

Background: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings. Methods: From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG). Results: The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs. Conclusion: Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.

scholarly journals Minimally invasive treatment strategy for partially thrombosed anterior inferior cerebellar artery aneurysm: A case report

2021 ◽  
Vol 12 ◽  
pp. 195
Author(s):  
Hirotaka Inoue ◽  
Takayuki Kawano ◽  
Yasuyuki Kaku ◽  
Akitake Mukasa
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Treatment Strategies ◽  
Artery Aneurysm ◽  
Invasive Procedure ◽  
Minimally Invasive Treatment ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Invasive Treatment ◽  
Cerebellar Artery

Background: Partially thrombosed anterior inferior cerebellar artery (AICA) aneurysms are extremely rare; thus, no established therapeutic approach exists. Case Description: We report a large, partially thrombosed AICA aneurysm and discuss its therapeutic nuances. The aneurysm was asymptomatic; therefore, we aimed to treat it through a minimally invasive procedure. The aneurysm was of fusiform type and the proximal neck of the aneurysm was positioned at midline in front of the brainstem. To approach the neck, posterior transpetrosal approach is recommended. However, this approach can be invasive; thus, we performed distal clipping of the aneurysm using transcondylar fossa approach with occipital artery-AICA bypass to avoid ischemia of the AICA territory. Although the size of the aneurysm initially increased, it subsequently decreased. Conclusion: This is a rare case report describing the long-term clinical course after distal clipping in detail. We showed that traditional microsurgical techniques can be applied to treat patients with new, minimally invasive treatment strategies.

Tandem Bypass: Occipital Artery to Posterior Inferior Cerebellar Artery Side-to-Side Anastomosis and Occipital Artery to Anterior Inferior Cerebellar Artery End-to-Side Anastomosis—a Case Report

Neurosurgery ◽  
1988 ◽  
Vol 22 (5) ◽  
pp. 919-922 ◽  
Author(s):  
James I. Ausman ◽  
Jeffrey E. Pearce ◽  
Dante F. Vacca ◽  
Fernando G. Diaz ◽  
Carl E. Shrontz ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Cerebellar Artery

Abstract A unique example of posterior fossa revascularization is presented. A tandem bypass was performed by anastomosing the midoccipital artery to the posterior inferior cerebellar artery in a side-to-side fashion followed by an anastomosis of the distal occipital artery to the anterior inferior cerebellar artery in an end-to-side fashion. The operation was designed to revascularize two separate vascular territories that were isolated in a patient thought to have an extremely compromised posterior circulation. The patient is doing well and is asymptomatic 3 years postoperatively.

Intracranial Vertebral Endarterectomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 465-471 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Balaji Sadasivan ◽  
Manuel Dujovny
Keyword(s):  
Vertebral Artery ◽  
Medical Therapy ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Focal Lesion ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

Deep Bypasses to the Distal Posterior Circulation

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 92-101 ◽  
Author(s):  
Zsolt Zador ◽  
Daniel C. Lu ◽  
Christine M. Arnold ◽  
Michael T. Lawton
Keyword(s):  
Temporal Lobe ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Brain Shift ◽  
Morphometric Measurements ◽  
Subtemporal Approach ◽  
Cerebellar Artery

Abstract OBJECTIVE The subtemporal approach for a superficial temporal artery–to–superior cerebellar artery bypass requires significant superior retraction that can injure the temporal lobe, compromise veins, and cause edema postoperatively. In contrast, the pretemporal approach requires posterolateral retraction that seems to be less injurious to the temporal lobe and better tolerated clinically. We hypothesized that the pretemporal approach provides ample exposure, more gentle retraction, and better clinical results than the subtemporal approach. METHODS Standard orbitozygomatic-pterional and subtemporal approaches were performed on both sides of 4 formalin-fixed cadaver heads for morphometric measurements. Temporal lobe retraction was quantified for each approach in terms of brain shift and retraction pressure by using both sides of 3 fresh, unfixed cadaver heads. Similar morphometric measurements were made in 14 patients in whom bypasses to the distal posterior circulation were performed. The effect of temporal lobe retraction was assessed with edema volumes on postoperative computed tomography scans. RESULTS In cadaver heads and in patients, the pretemporal approach optimized exposure of the P2A segment of the posterior cerebral artery (PCA) and the subtemporal approach optimized exposure of the lateral pontomesencephalic segment of the superior cerebellar artery (SCA). Working depths and lengths of exposed artery were similar with these 2 approaches, but the PCA was a larger recipient than the SCA. Brain shift was 42% less with pretemporal than with subtemporal retraction, and retraction pressure was 43% less with pretemporal than with subtemporal retraction. The volume of temporal lobe edema was 56% less in patients with bypasses performed with the pretemporal approach as compared with the subtemporal approach. CONCLUSION Pretemporal exposure of the PCA is equivalent to subtemporal exposure of the SCA, but the pretemporal approach is facilitated by a larger recipient artery. Posterolateral temporal lobe retraction associated with the pretemporal approach is gentler than superior retraction with the subtemporal approach. These results validate our preference for the pretemporal approach over the subtemporal approach when performing deep bypasses to the posterior circulation.

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