Bypass Surgery for Vertebral Artery and Posterior Inferior Cerebellar Artery Fusiform Aneurysms: Surgical Technique and Key Lessons

Muhammad Kusdiansah, Arnau Benet, Yosuke Suzuki, Kenichi Haraguchi, Nakao Ota, Kosumo Noda, Rokuya Tanikawa

研究成果: ジャーナルへの寄稿学術論文査読

抄録

Fusiform vertebral artery (VA) aneurysms are challenging to treat due to their pathophysiology, morphology, and anatomic location.1,2 Endovascular treatments are considered to be a widely adopted safe option for this pathology.1 Open microsurgical treatment is considered for complex anatomy, important branch involvement, poor collateral flow, or failed endovascular therapy.3-7 This report aims to show the flow-replacement strategy and bypass technique for a VA aneurysm with complex anatomy and branch involvement. A 24-year-old man presented to our clinic with a bilateral fusiform VA aneurysm discovered during workup of progressive headaches. Further investigation revealed that the left-side aneurysm was mostly thrombosed and the posterior inferior cerebellar artery arose from the aneurysm dome with a fusiform enlargement within a few millimeters from the branching point. After evaluating all management options, the patient decided on surgical treatment of the left VA aneurysm. We performed an occipital artery to posterior inferior cerebellar artery end-to-side anastomosis distal to the fusiform enlargement, followed by trapping of the aneurysm and dome resection (Video 1). Antegrade flow to the distal VA was reestablished using a radial artery interposition graft, thus preventing any flow alterations that may cause growth or rupture of the contralateral aneurysm caused by increased hemodynamic stress if the ipsilateral VA flow is not preserved.8 After in-hospital physical rehabilitation, the patient was discharged with a modified Rankin Scale score of 1. The contralateral aneurysm is managed with serial imaging and treatment will ensue if there is clinical-radiologic evolution. The patient consented to the procedure and publication of his image.

本文言語英語
ページ(範囲)59
ページ数1
ジャーナルWorld Neurosurgery
181
DOI
出版ステータス出版済み - 01-2024
外部発表はい

All Science Journal Classification (ASJC) codes

  • 外科
  • 臨床神経学

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