Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation

Durward, Quentin J.

doi:10.3171/jns.1995.82.1.0137

Cited by 56 publications

(24 citation statements)

References 8 publications

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“…[5][6][7][8][9]13,14,19,22,29 PICA-PICA bypass was the most common IC-IC bypass, and only 4 cases of PICA reimplantation were reported. 4,12,20,26 The limited application of IC-IC bypass may be explained by the rarity of dysmorphic PICA aneurysms, but there are other reasons that deserve consideration. First, these are technically challenging bypasses.…”

Section: Bypass Indicationsmentioning

confidence: 99%

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Abla¹,

McDougall²,

Lawton³

2016

JNS

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I ntracranIal-to-IntracranIal (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize efferent branches with in situ donor arteries, and reconstruct bifurcated anatomy with interposition grafts that are entirely intracranial. 25 These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites in the neck toward a more local and reconstructive approach, or, in other words, a more minimally invasive approach to byabbreviatioNs DSA = digital subtraction angiography; EC-IC = extracranial-to-intracranial; IC-IC = intracranial-to-intracranial; mRS = modified Rankin Scale; PICA = posterior inferior cerebellar artery; RAG = radial artery interposition graft; VA = vertebral artery. obJective Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. methods Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. results During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V 3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. coNclusioNs PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one-quarter of all PICA aneurysms treated microsurgically at our center requiring bypass without a single EC-IC bypass. The selection of PICA bypass is almost algorithmic: trapped aneurysms at the PICA origin or p1 segment are revasculari...

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Section: Bypass Indicationsmentioning

confidence: 99%

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Abla¹,

McDougall²,

Lawton³

2016

JNS

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“…Occlusion of perforating arteries arising from the distal VA is likely to be responsible for such infarctions, and the length of the occlusion should be minimized as much as possible to avoid this complication [3,4]. Treatment of VA dissection involving the PICA origin is the most problematic [8,9]: inadvertent occlusion of the PICA causes serious brainstem/cerebellar infarctions, whereas incomplete packing of the dissection with the hope of sparing the PICA is no more effective or safe.…”

mentioning

confidence: 99%

Endovascular Treatment of Ruptured Vertebral Artery Dissection in the Acute Stage

Inamasu

Nakamura²,

Saito³

et al. 2003

Cerebrovasc Dis

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“…It is believed that a cerebral dissecting aneurysm is formed by the sudden widespread disruption of the internal elastic lamina [11,12], which results in a high risk of rebleeding in the acute stage [3,9,13]. Surgical trapping may be the most reliable method to prevent rerupture and was widely used before endovascular treatment was available [14,15]. However, this treatment is quite invasive, may precipitate the Wallenberg syndrome or other disastrous events [9,16], and has been replaced gradually by internal trapping [3,[17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

Fang

Zhao

Zhou

et al. 2014

Cardiovasc Intervent Radiol

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Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation

Cited by 56 publications

References 8 publications

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Endovascular Treatment of Ruptured Vertebral Artery Dissection in the Acute Stage

Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

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