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.

Revascularization and Aneurysm Surgery

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 482-498 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Wyatt Ramey ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Aneurysm Surgery ◽  
Cerebellar Artery

Abstract BACKGROUND: Given advances in endovascular technique, the indications for revascularization in aneurysm surgery have declined. OBJECTIVE: We sought to define indications, outline technical strategies, and evaluate the outcomes of patients treated with bypass in the endovascular era. METHODS: We retrospectively reviewed all aneurysms treated between September 2006 and February 2013. RESULTS: We identified 54 consecutive patients (16 males and 39 females) with 56 aneurysms. Aneurysms were located along the cervical internal carotid artery (ICA) (n = 1), petrous/cavernous ICA (n = 1), cavernous ICA (n = 16), supraclinoid ICA (n = 7), posterior communicating artery (n = 2), anterior cerebral artery (n = 4), middle cerebral artery (MCA) (n = 13), posterior cerebral artery (PCA) (n = 3), posterior inferior cerebellar artery (n = 4), and vertebrobasilar arteries (n = 5). Revascularization was performed with superficial temporal artery (STA) to MCA bypass (n = 25), STA to superior cerebellar artery (SCA) (n = 3), STA to PCA (n = 1), STA-SCA/STA-PCA (n = 1), occipital artery (OA) to PCA (n = 2), external carotid artery/ICA to MCA (n = 15), OA to MCA (n = 1), OA to posterior inferior cerebellar artery (n = 1), and in situ bypasses (n = 8). At a mean clinical follow-up of 18.5 months, 45 patients (81.8%) had a good outcome (Glasgow Outcome Scale 4 or 5). There were 7 cases of mortality (12.7%) and an additional 9 cases of morbidity (15.8%). At a mean angiographic follow-up of 17.8 months, 14 bypasses were occluded. Excluding the 7 cases of mortality, the majority of aneurysms (n = 42) were obliterated. We identified 7 cases of residual aneurysm and recurrence in 6 patients at follow-up. CONCLUSION: Given current limitations with existing treatments, cerebral revascularization remains an essential technique for aneurysm surgery.

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.

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.

Variations of Occipital Artery-Posterior Inferior Cerebellar Artery Bypass: Anatomic Consideration

2017 ◽  
Vol 14 (5) ◽  
pp. 563-571 ◽  
Author(s):  
Ken Matsushima ◽  
Satoshi Matsuo ◽  
Noritaka Komune ◽  
Michihiro Kohno ◽  
J Richard Lister
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Jugular Foramen ◽  
Occipital Artery ◽  
Parent Artery ◽  
Microsurgical Anatomy ◽  
Main Trunk ◽  
Cerebellar Artery ◽  
Cerebellomedullary Fissure ◽  
Pica Aneurysms

Abstract BACKGROUND Advances in diagnosis of posterior inferior cerebellar artery (PICA) aneurysms have revealed the high frequency of distal and/or dissecting PICA aneurysms. Surgical treatment of such aneurysms often requires revascularization of the PICA including but not limited to its caudal loop. OBJECTIVE To examine the microsurgical anatomy involved in occipital artery (OA)-PICA anastomosis at various anatomic segments of the PICA. METHODS Twenty-eight PICAs in 15 cadaveric heads were examined with the operating microscope to take morphometric measurements and explore the specific anatomy of bypass procedures. RESULTS OA bypass to the p2, p3, p4, or p5 segment was feasible with a recipient vessel of sufficient diameter. The loop wandering near the jugular foramen in the p2 segment provided sufficient length without requiring cauterization of any perforating arteries to the brainstem. Wide dissection of the cerebellomedullary fissure provided sufficient exposure for the examination of some p3 segments and all p4 segments hidden by the tonsil. OA-p5 bypass was placed at the main trunk before the bifurcation in 5 hemispheres and at the larger hemispheric trunk in others. CONCLUSION Understanding the possible variations of OA-PICA bypass may enable revascularization of the appropriate portion of the PICA when the parent artery must be occluded. A detailed anatomic understanding of each segment clarifies important technical nuances for the bypass on each segment. Dissection of the cerebellomedullary fissure helps to achieve sufficient exposure for the bypass procedures on most of the segments.

How I do it: occipital artery to posterior inferior cerebellar artery bypass

2014 ◽  
Vol 156 (5) ◽  
pp. 971-975 ◽  
Author(s):  
Erez Nossek ◽  
David J. Chalif ◽  
Amir R. Dehdashti
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Cerebellar Artery
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