Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

In Situ Intersegmental Anastomosis within a Single Artery for Treatment of an Aneurysm at the Posterior Inferior Cerebellar Artery : Closing Omega Bypass

  • Lee, Sung Ho (Department of Neurosurgery, College of Medicine, Kyung Hee University) ;
  • Choi, Seok Keun (Department of Neurosurgery, College of Medicine, Kyung Hee University)
  • Received : 2014.07.27
  • Accepted : 2014.09.23
  • Published : 2015.11.28
Download PDF
⟨ Previous Next ⟩

Abstract

A 74-year-old patient was diagnosed with a subarachnoid hemorrhage suspected from a dissecting aneurysm located at the lateral medullary segment of the posterior inferior cerebellar artery (PICA). Because perforators to the medulla arose both proximal and distal to the dissecting segment, revascularization for distal flow was essential. However, several previously reported methods for anastomosis, such as an occipital artery-PICA bypass or resection with PICA end-to-end anastomosis could not be used. Ultimately, we performed an in situ side-to-side anastomosis of the proximal loop of the PICA with distal caudal loops within a single artery, as a "closing omega," followed by trapping of the dissected segment. The aneurysm was obliterated successfully, with intact patency of the revascularized PICA.

Keywords

References

  1. Al-khayat H, Al-Khayat H, Beshay J, Manner D, White J : Vertebral artery-posteroinferior cerebellar artery aneurysms : clinical and lower cranial nerve outcomes in 52 patients. Neurosurgery 56 : 2-10; discussion 11, 2005 https://doi.org/10.1097/00006123-200501001-00002
  2. Ali MJ, Bendok BR, Tawk RG, Getch CC, Batjer HH : Trapping and revascularization for a dissecting aneurysm of the proximal posteroinferior cerebellar artery : technical case report and review of the literature. Neurosurgery 51 : 258-262; discussion 262-263, 2002 https://doi.org/10.1097/00006123-200207000-00043
  3. Ausman JI, Diaz FG, Vacca DF, Sadasivan B : Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for vertebrobasilar insufficiency. J Neurosurg 72 : 554-558, 1990 https://doi.org/10.3171/jns.1990.72.4.0554
  4. Crowley RW, Medel R, Dumont AS : Operative nuances of an occipital artery to posterior inferior cerebellar artery bypass. Neurosurg Focus 26 : E19, 2009 https://doi.org/10.3171/2009.2.FOCUS0911
  5. Dinichert A, Rufenacht DA, Tribolet N : Dissecting aneurysms of the posterior inferior cerebellar artery : report of four cases and review of the literature. J Clin Neurosci 7 : 515-520, 2000 https://doi.org/10.1054/jocn.2000.0757
  6. Evans JJ, Sekhar LN, Rak R, Stimac D : Bypass grafting and revascularization in the management of posterior circulation aneurysms. Neurosurgery 55 : 1036-1049, 2004 https://doi.org/10.1227/01.NEU.0000140822.64362.C6
  7. Kawashima M, Rhoton AL Jr, Tanriover N, Ulm AJ, Yasuda A, Fujii K : Microsurgical anatomy of cerebral revascularization. Part II : posterior circulation. J Neurosurg 102 : 132-147, 2005 https://doi.org/10.3171/jns.2005.102.1.0132
  8. Kocyigit A, Cinar C, Kitis O, Calli C, Oran I : Isolated PICA dissection : an unusual complication of scuba diving : case report and review of the literature. Clin Neuroradiol 20 : 171-173, 2010 https://doi.org/10.1007/s00062-010-0002-0
  9. Koh JS, Lee CY, Lee SH, Kim GK : Dissecting aneurysm associated with a double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage. J Korean Neurosurg Soc 51 : 40-43, 2012 https://doi.org/10.3340/jkns.2012.51.1.40
  10. Korja M, Sen C, Langer D : Operative nuances of side-to-side in situ posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass procedure. Neurosurgery 67 (2 Suppl Operative) : 471-477, 2010 https://doi.org/10.1227/01.NEU.0000372205.53792.E4
  11. Lemole GM Jr, Henn J, Javedan S, Deshmukh V, Spetzler RF : Cerebral revascularization performed using posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass. Report of four cases and literature review. J Neurosurg 97 : 219-223, 2002 https://doi.org/10.3171/jns.2002.97.1.0219
  12. Lewis SB, Chang DJ, Peace DA, Lafrentz PJ, Day AL : Distal posterior inferior cerebellar artery aneurysms : clinical features and management. J Neurosurg 97 : 756-766, 2002 https://doi.org/10.3171/jns.2002.97.4.0756
  13. Lister JR, Rhoton AL Jr, Matsushima T, Peace DA : Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery 10 : 170-199, 1982 https://doi.org/10.1227/00006123-198202000-00004
  14. Maimon S, Saraf-Lavi E, Rappaport ZH, Bachar G : Endovascular treatment of isolated dissecting aneurysm of the posterior inferior cerebellar artery. AJNR Am J Neuroradiol 27 : 527-532, 2006
  15. Nussbaum ES, Madison MT, Goddard JK, Lassig JP, Janjua TM, Nussbaum LA : Remote distal outflow occlusion : a novel treatment option for complex dissecting aneurysms of the posterior inferior cerebellar artery. Report of 3 cases. J Neurosurg 111 : 78-83, 2009 https://doi.org/10.3171/2009.1.JNS081250
  16. Nussbaum ES, Madison MT, Myers ME, Goddard J, Janjua T : Dissecting aneurysms of the posterior inferior cerebellar artery : retrospective evaluation of management and extended follow-up review in 6 patients. J Neurosurg 109 : 23-27, 2008 https://doi.org/10.3171/JNS/2008/109/7/0023
  17. Quinones-Hinojosa A, Lawton MT : In situ bypass in the management of complex intracranial aneurysms : technique application in 13 patients. Neurosurgery 57 (1 Suppl) : 140-145; discussion 140-145, 2005
  18. Sedat J, Chau Y, Mahagne MH, Bourg V, Lonjon M, Paquis P : Dissection of the posteroinferior cerebellar artery : clinical characteristics and long-term follow-up in five cases. Cerebrovasc Dis 24 : 183-190, 2007 https://doi.org/10.1159/000104475
  19. Takahashi I, Takamura H, Gotoh S, Sasaki H, Makino K, Suzuki N, et al. : [Dissecting aneurysm of the posterior inferior cerebellar artery; a case report]. No Shinkei Geka 20 : 277-281, 1992
  20. Taylor AG, Tymianski M, Terbrugge K : A dissecting aneurysm of the posterior inferior cerebellar artery. A case report. Interv Neuroradiol 7 : 253-257, 2001 https://doi.org/10.1177/159101990100700312
  21. Yamakawa H, Kaku Y, Yoshimura S, Ohkuma A, Sakai N : Two cases of dissecting aneurysm of the distal posterior inferior cerebellar artery : possible involvement of segmental mediolytic arteriopathy in the pathogenesis. Clin Neurol Neurosurg 107 : 117-122, 2005 https://doi.org/10.1016/j.clineuro.2004.01.007
  22. Yamaura I, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, et al. : Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90 : 853-856, 1999 https://doi.org/10.3171/jns.1999.90.5.0853