Bypass surgery for ruptured dissecting aneurysms of the proximal posterior cerebral artery: illustrative case

Abstract

BACKGROUND Posterior cerebral artery (PCA) dissecting aneurysms commonly occur in the proximal PCA and are considered rare. The treatment of proximal PCA dissecting aneurysms is challenging because of the existence of perforators supplying the vital neural structures. Recently, endovascular intervention has been used; however, concerns for ischemic or hemorrhagic complications exist. OBSERVATIONS A 54-year-old woman presented with subarachnoid hemorrhage due to dissecting aneurysm rupture at the P1-P2 junction of the PCA. The thalamoperforating artery (TPA) and medial posterior choroidal artery (MPchA) originated from the proximal end and the distal end of the aneurysm, respectively. Additionally, the posterior communicating artery (PcomA) connected with the dissected segment. To preserve these perforators, we performed surgical trapping combined with superficial temporal artery (STA) PCA anastomosis. Clips were applied for trapping the proximal and distal end of the aneurysm, with preservation of the TPA and MPchA origin. PcomA was left open for blood flow preservation to the perforators directly arising from the aneurysm. The postoperative course was uneventful, and the patient was discharged. LESSONS Surgical trapping using STA-PCA bypass could be a treatment of choice for proximal PCA dissecting aneurysms, considering its potential for cure and prevention of ischemic complications.

Quantitative Analysis of Occipital Artery Bypass Donor Vessels by Ultrasonography and DSA

“…The diameter of the OA likely may not provide enough blood flow for flow replacement in the posterior circulation. As reported, high-flow bypass is always required for flow replacement in posterior fossa bypass, 22 and blood flow of High-flow bypass is about 70 to 140 mL/min 23 ; however, the OA could only offer a mean blood flow of 15 to 80 mL/min in posterior fossa bypass 24 . In theory, insufficient blood flow offered by occipital artery bypasses may lead to cerebral infarction.…”