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A case of endovascular treatment for followed by side to side bypass for vertebral artery dissecting aneurysms involved posterior inferior cerebellar artery.

Chung SY, Yoon BH, Park MS, Kim SM - J Korean Neurosurg Soc (2014)

Bottom Line: We recently experienced a case of vertebral artery dissecting aneurysm and obtained good treatment outcomes.The aneurysmal sac was completely obliterated.In conclusion our case suggests that the endovascular segmental occlusion of the parent artery followed by PICA to PICA bypass surgery through a midline suboccipital approach is a reasonable multimodal treatment option in patients with complex vertebral artery dissecting aneurysms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea.

ABSTRACT
Treatment of complex aneurysms usually entails not only direct clipping but also alternative treatment modality. We recently experienced a case of vertebral artery dissecting aneurysm and obtained good treatment outcomes. Our case suggests that the endovascular segmental occlusion with posterior inferior cerebellar artery (PICA) to PICA side anastomosis might be a good treatment option in patients with complex vertebral artery dissecting aneurysms. A 45-year-old woman has a left vertebral dissecting aneurysm with dizziness. Based on the aneurysmal morphology and the involvement of PICA, the patient underwent side to side anastomosis of the PICA. This was followed by the endovascular segmental coil occlusion. The aneurysmal sac was completely obliterated. At a 2-year follow-up, the patient achieved a good patency of both PICA. In conclusion our case suggests that the endovascular segmental occlusion of the parent artery followed by PICA to PICA bypass surgery through a midline suboccipital approach is a reasonable multimodal treatment option in patients with complex vertebral artery dissecting aneurysms.

No MeSH data available.


Related in: MedlinePlus

Posterior inferior cerebellar artery (PICA) to PICA side anastomosis was done and the patency looks well by intraoperative indocyanine green angiography.
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Figure 4: Posterior inferior cerebellar artery (PICA) to PICA side anastomosis was done and the patency looks well by intraoperative indocyanine green angiography.

Mentions: After a midline suboccipital craniotomy, the cisterna magna was opened. After temporary clipping of proximal and distal PICA and perforating artery, a curved incision rather than a straight one along the PICA was done. To do this, the distal end of both PICA was stay-sutured. This was followed by the continuous suture from outside to inside of inner side of the vessel. Then, the final suture was done from inside to outside of the vessel. Following this, the proximal end was also stay-sutured on the external side and then tied with the final inner suture. Moreover, the continuous suture of outer side from outside to inside of the vessel was done in the same manner. After removal of temporary clips, a good patency was also seen on intraoperative indocyanine green angiography (Fig. 4).


A case of endovascular treatment for followed by side to side bypass for vertebral artery dissecting aneurysms involved posterior inferior cerebellar artery.

Chung SY, Yoon BH, Park MS, Kim SM - J Korean Neurosurg Soc (2014)

Posterior inferior cerebellar artery (PICA) to PICA side anastomosis was done and the patency looks well by intraoperative indocyanine green angiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928346&req=5

Figure 4: Posterior inferior cerebellar artery (PICA) to PICA side anastomosis was done and the patency looks well by intraoperative indocyanine green angiography.
Mentions: After a midline suboccipital craniotomy, the cisterna magna was opened. After temporary clipping of proximal and distal PICA and perforating artery, a curved incision rather than a straight one along the PICA was done. To do this, the distal end of both PICA was stay-sutured. This was followed by the continuous suture from outside to inside of inner side of the vessel. Then, the final suture was done from inside to outside of the vessel. Following this, the proximal end was also stay-sutured on the external side and then tied with the final inner suture. Moreover, the continuous suture of outer side from outside to inside of the vessel was done in the same manner. After removal of temporary clips, a good patency was also seen on intraoperative indocyanine green angiography (Fig. 4).

Bottom Line: We recently experienced a case of vertebral artery dissecting aneurysm and obtained good treatment outcomes.The aneurysmal sac was completely obliterated.In conclusion our case suggests that the endovascular segmental occlusion of the parent artery followed by PICA to PICA bypass surgery through a midline suboccipital approach is a reasonable multimodal treatment option in patients with complex vertebral artery dissecting aneurysms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea.

ABSTRACT
Treatment of complex aneurysms usually entails not only direct clipping but also alternative treatment modality. We recently experienced a case of vertebral artery dissecting aneurysm and obtained good treatment outcomes. Our case suggests that the endovascular segmental occlusion with posterior inferior cerebellar artery (PICA) to PICA side anastomosis might be a good treatment option in patients with complex vertebral artery dissecting aneurysms. A 45-year-old woman has a left vertebral dissecting aneurysm with dizziness. Based on the aneurysmal morphology and the involvement of PICA, the patient underwent side to side anastomosis of the PICA. This was followed by the endovascular segmental coil occlusion. The aneurysmal sac was completely obliterated. At a 2-year follow-up, the patient achieved a good patency of both PICA. In conclusion our case suggests that the endovascular segmental occlusion of the parent artery followed by PICA to PICA bypass surgery through a midline suboccipital approach is a reasonable multimodal treatment option in patients with complex vertebral artery dissecting aneurysms.

No MeSH data available.


Related in: MedlinePlus