Blind-Alley Formation and Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for the Treatment of Unclippable Vertebral Artery Aneurysms with Posterior Inferior Cerebellar Artery Involvement

2020 ◽  
Vol 138 ◽  
pp. e539-e550
Author(s):  
Somkiat Wongsuriyanan ◽  
Kitiporn Sriamornrattanakul
Keyword(s):  
Vertebral Artery ◽  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Blind Alley ◽  
Cerebellar Artery

Preoperative Considerations in Occipital Artery-high-riding Posterior Inferior Cerebellar Artery Bypass: A Report of Two Cases and a Literature Review

2019 ◽  
Vol 80 (05) ◽  
pp. 399-403
Author(s):  
Yeong-Jin Kim ◽  
Jae-Young Kim ◽  
Yong-Hwan Cho ◽  
You-Sub Kim ◽  
Tae-Sun Kim ◽  
...  
Keyword(s):  
Literature Review ◽  
Vertebral Artery ◽  
Skull Base ◽  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Anatomical Features ◽  
Significant Challenge ◽  
Cerebellar Artery ◽  
Technical Considerations

AbstractNonsaccular vertebral artery aneurysms involving the posterior inferior cerebellar artery (PICA) are rare. Treatment is considered a significant challenge because of their angiographic and anatomical features, especially in high-riding PICA. Therefore, meticulous preoperative angiographic and anatomical evaluation is necessary. Moreover, consideration of the distance between the cerebellar skull base and caudal loop of the PICA is important. We present two cases of occipital artery-high-riding PICA bypass and discuss important preoperative technical considerations.

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.

Operative nuances of an occipital artery to posterior inferior cerebellar artery bypass

2009 ◽  
Vol 26 (5) ◽  
pp. E19 ◽  
Author(s):  
R. Webster Crowley ◽  
Ricky Medel ◽  
Aaron S. Dumont
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Complex Aneurysms ◽  
Cerebellar Artery ◽  
Proximal Occlusion ◽  
Attention To Detail

Occipital artery to posterior inferior cerebellar artery bypasses remain an important tool for cerebrovascular neurosurgeons, particularly in the management of complex aneurysms of the posterior inferior cerebellar artery requiring proximal occlusion or trapping. The procedure requires meticulous technique and attention to detail. The authors outline their technique for accomplishing this bypass emphasizing nuances for complication avoidance.

Vertebral Artery Disease

Neurosurgery ◽  
1981 ◽  
Vol 9 (5) ◽  
pp. 524-530 ◽  
Author(s):  
Michael B. Pritz ◽  
William F. Chandler ◽  
Glenn W. Kindt
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Medical Management ◽  
Posterior Inferior Cerebellar Artery ◽  
External Carotid Artery ◽  
The Other ◽  
External Carotid ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Artery Disease

Abstract The neuroradiological evaluation, perioperative medical management, and microsurgical treatment of variously located vertebral artery lesions are presented. Four types of surgical procedures were undertaken: proximal vertebral artery to common carotid artery end-to-side anastomosis; external carotid artery to midcervical vertebral artery end-to-side anastomosis; external carotid artery to distal cervical vertebral artery end-to-end anastomosis; and occipital artery to posterior inferior cerebellar artery end-to-side anastomosis. Each case is used to demonstrate the evaluation and management involved, the type of and rationale for the surgical procedure selected, and the patency of the anastomosis performed. Two points are emphasized. One is that, after careful angiographic evaluation and improved perioperative medical management, lesions of the vertebral artery are indeed amenable to microsurgical intervention with relatively low risk to the patient. The other is that, whenever possible, anastomosis of the largest caliber of vessels with the least number of suture lines is the surgical treatment of choice.

Occipital Artery to Posterior Inferior Cerebellar Artery Bypass for Vertebrobasilar Ischemia

Neurosurgery ◽  
1982 ◽  
Vol 10 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Richard A. Roski ◽  
Robert F. Spetzler ◽  
Leo N. Hopkins
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Graft Patency ◽  
Occipital Artery ◽  
Operative Morbidity ◽  
Intraoperative Hypotension ◽  
Vertebrobasilar Ischemia ◽  
Cerebellar Artery ◽  
Noticeable Improvement

Abstract Fourteen patients who underwent occipital to posterior inferior cerebellar arterial bypass are reviewed. All of the patients were treated for severe vertebrobasilar ischemia secondary to lesions of the distal vertebral artery. There was no operative death or permanent postoperative morbidity. On follow-up evaluation (averaging 13 months after operation), there has been 100% graft patency and a noticeable improvement in the neurological function in all patients. Operating with the patient in the prone position and avoiding intraoperative hypotension help to minimize the operative morbidity from this procedure.

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