Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion
Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion
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DOI：
10.1016/j.surneu.2003.06.001
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发表时间：
2004-02-01
影响因子：
--
通讯作者：
Ogawa, A
中科院分区：
文献类型：
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作者：
Kakino, S;Ogasawara, K;Ogawa, A
研究背景涉及小脑后下动脉(PICA)起始部的动脉瘤患者需要闭塞椎动脉(VA)，通常进行PICA血运重建术。方法对6例VA夹层动脉瘤患者行PICA-PICA吻合联合载瘤动脉闭塞。方法枕下低位开颅联合颈静脉结节部分切除后，在PICA后髓段行侧侧吻合。结果6例患者中，5例术后脑血管造影术显示动脉瘤吻合通畅，动脉瘤消退。其余患者发生对侧VA夹层出血，随后死亡。1例患者继发于术中固定板压迫所致的下肢肌病，并出现永久性的下肢肌肉无力。结论PICA-PICA吻合术是一种有效的重建PICA的方法，但需要阻断载瘤血管以排除累及PICA起始处的VA。(C)2004 Elsevier Inc.保留所有权利。
BACKGROUND Inpatients with aneurysms that involve the origin of the posterior inferior cerebellar artery (PICA) and require occlusion of the vertebral artery (VA), revascularization of the PICA is commonly performed. We present six patients with dissecting VA aneurysms who underwent PICA-PICA anastomosis combined with parent artery occlusion.METHODS After a lower lateral suboccipital craniectomy and partial resection of the jugular tubercle, anastomoses were performed in a side-to-side fashion at the posterior medullary segment of the PICA. The VA was subsequently occluded by clipping proximal and distal to the aneurysm, and the PICA was occluded by clipping distal to the aneurysm.RESULTS Postoperative cerebral angiography demonstrated patency of the anastomosis and regression of the aneurysm in five of six patients. The remaining patient experienced hemorrhage from contralateral VA dissection and subsequently died. One patient experienced myopathy of the lower extremities secondary to intraoperative fixed board compression and developed permanent lower extremity muscular weakness. The remaining four cases experienced no new neurologic deficits.CONCLUSION PICA-PICA anastomosis is a useful procedure for reconstruction of the PICA when parent vessel occlusion or trapping is necessary to exclude a VA aneurysm involving the origin of the PICA. (C) 2004 Elsevier Inc. All rights reserved.