Vertebral Artery-to-Vertebral Artery Bypass with Interposed Radial Artery or Occipital Artery Grafts: Surgical Technique and Report of Three Cases

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• 作者：Hisashi Kubota ; Rokuya Tanikawa ; Makoto Katsuno ; Naoto Izumi ; Kosumo Noda ; Nakao Ota ; Yohei Ishishita ; Takanori Miyazaki ; Shinichi Okabe ; Sumio Endo ; Mika Niemel盲 ; Masaaki Hashimoto
• 关键词：Everting technique ; Intracranial vertebral artery reconstruction ; Occipital artery graft ; Radial artery graft ; Vertebral artery-to-vertebral artery bypass
• 刊名：World Neurosurgery
• 出版年：January, 2014
• 年：2014
• 卷：81
• 期：1
• 页码：202.e1-202.e8
• 全文大小：2974 K

文摘

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Background

The treatment of unclippable vertebral artery (VA) aneurysms incorporating the posterior inferior cerebellar artery with parent artery preservation is among one of the most formidable challenges for cerebrovascular microsurgery and endovascular surgery. We propose that intracranial VA reconstruction using an extracranial VA-to-intracranial VA (VA-VA) bypass with a radial artery graft or an occipital artery graft may be an additional technique in the armamentarium to treat these formidable lesions. The rationale, surgical technique, and complications are discussed.

Methods

Three illustrative cases are described, in which the lesions were a VA dissecting aneurysm with ischemic lesions, bilateral asymptomatic unruptured VA aneurysms, and a VA giant aneurysm with subarachnoid hemorrhage.

Results

The partial extreme lateral infrajugular transcondylar approach was used. Computed tomographic angiography was useful for preoperative evaluation of the depth of the distal aneurysmal neck. A VA-VA bypass was performed in two patients. Because there was another ipsilateral aneurysm at the V2 segment in one patient, an external carotid artery-VA bypass was performed. Although two patients were discharged with good clinical results, one patient with subarachnoid hemorrhage died because of brainstem infarction.

Conclusions

The VA-VA bypass using a radial artery graft or an occipital artery graft is an option that can be considered in the strategy for treating VA aneurysms to preserve the normal anatomic vascular configuration in the posterior circulation.