Bypass Revascularization Applied to the Posterior Cerebral Artery

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• 作者：Nakao Ota¹ ; Felix Goehre² ; Takanori Miyazaki¹ ; Yu Kinoshita¹ ; Hidetoshi Matsukawa¹ ; Takeshi Yanagisawa¹ ; Fumihiro Sakakibara¹ ; Norihiro Saito¹ ; Shiro Miyata¹ ; Kosumo Noda¹ ; Toshiyuki Tsuboi¹ ; Hiroyasu Kamiyama¹ ; Sadahisa Tokuda¹ ; Kyousuke Kamada³ ; Rokuya Tanikawa¹ ; ^{taniroku@gmail.com}
• 关键词：Aneurysm ; Anterior temporal approach ; Bypass ; Combined transpetrosal approach ; Posterior cerebral artery ; Posterior interhemispheric approach
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：96
• 期：Complete
• 页码：460-472
• 全文大小：6737 K
• 卷排序：96

文摘

The application of bypass procedures to the posterior cerebral artery (PCA) in combination with proximal clipping or trapping is a useful option for the treatment of complex posterior circulation aneurysms, especially those of the PCA. Because of its course around the midbrain through various cisterns, different approaches are required to access the PCA.ObjectiveThe presented study analyzes a retrospective case series of bypass procedures to the PCA to investigate the relevant treatment strategies and their outcomes.MethodsSeven patients with bypass procedures to the PCA bypass were analyzed. The location of the aneurysms, approaches, site of anastomosis, bypass patency, pre- and postoperative modified Rankin Scale scores, and transient and permanent morbidity were assessed.ResultsAnalyzed patients were treated for intracranial aneurysm located on the P2 (n = 3) or P3 (n = 2) of the PCA, bilateral vertebral artery dissecting aneurysm (n = 1) or internal carotid artery-posterior communicating artery aneurysm (n = 1). The following approaches were used: anterior temporal approach (n = 2), anterior temporal approach combined with subtemporal approach (n = 2), combined transpetrosal approach (n = 1), posterior interhemispheric approach (n = 1), and posterior interhemispheric approach with subtemporal approach (n = 1). All bypasses were patent. Permanent morbidity occurred in 2 patients via cognitive dysfunction (n = 1) and hemiparesis (n = 1).ConclusionsBypass revascularization of the PCA territory is effective for the treatment of complex vascular lesions affecting the posterior circulation. To address the various surgical segments of the PCA, different approaches are required. Combined approaches allow access to the PCA proximal and distal from the lesion.