Ruptured vertebral artery dissecting aneurysms involving a dominant posterior inferior cerebellar artery origin: A preferred indication for bypass surgery in clinical practice
| Autor: | Masashi Higashino, Shinichi Miura, Takashi Mizobe, Hideo Aihara, Taichiro Imahori, Eiji Kohmura, Kazuhiro Tanaka, Kohkichi Hosoda, Yusuke Yamamoto, Masahiro Sugihara, Takashi Sasayama |
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| Rok vydání: | 2021 |
| Předmět: |
Vertebral artery dissecting aneurysm
medicine.medical_specialty Subarachnoid hemorrhage Vertebral artery lcsh:Surgery Anastomosis lcsh:RC346-429 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm medicine.artery medicine Occipital artery lcsh:Neurology. Diseases of the nervous system business.industry Occipital artery to posterior inferior cerebellar artery bypass lcsh:RD1-811 medicine.disease Surgery Posterior inferior cerebellar artery medicine.anatomical_structure Bypass surgery Neurology (clinical) business Cerebellar artery 030217 neurology & neurosurgery |
| Zdroj: | Interdisciplinary Neurosurgery, Vol 23, Iss, Pp 100999-(2021) |
| ISSN: | 2214-7519 |
| Popis: | Background In clinical practice, the optimal treatment approach for ruptured vertebral artery dissecting aneurysm (VADA) involving a posterior inferior cerebellar artery (PICA) remains unclear. Here, we report two cases of ruptured VADA involving a dominant PICA that were successfully treated with surgical occlusion with occipital artery (OA) to PICA bypass, while avoiding postoperative ischemia. Case description The first patient was a 47-year-old woman who presented with a Hunt–Hess grade III, diffuse subarachnoid hemorrhage (SAH) due to a ruptured right VADA involving a PICA. The PICA was dominant, supplying a wide vascular territory in the right cerebellum (the “PICA–anterior inferior cerebellar artery” variant). The second patient was a 56-year-old man who presented with a Hunt–Hess grade II, localized SAH due to a ruptured right VADA involving a PICA. The PICA was also dominant, supplying a wide vascular territory in the bilateral cerebellum (the “bihemispheric PICA” variant). Both patients were treated with OA–PICA bypass, which was followed by surgical trapping of the VADA in the first patient and proximal clipping in the second patient on the day of the SAH onset. The postoperative course was uneventful, and magnetic resonance imaging showed no apparent ischemic change in the brainstem and cerebellum in either patient. Conclusions For ruptured VADA involving a PICA, dominance of the involved PICA may be a practically preferred indication for bypass surgery because of the severity of ischemia when a dominant PICA is sacrificed and because the vascular anatomy of a dominant PICA makes anastomosis feasible. |
| Databáze: | OpenAIRE |
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