Technical Consideration for Safe and Reliable Revascularization Procedure of the Superior Cerebellar Artery and the Posterior Cerebral Artery

Background: Revascularization of the superior cerebral artery (SCA) and the posterior cerebral artery (PCA) should be sometimes performed to treat cerebrovascular lesions in the posterior circulation. In revascularization of the SCA, subtemporal approach is widely used. In performing a bypass to the PCA, however, subtemporal approach cannot always provide adequate operative field. We chose the minimum transpetrosal (presigmoid retrolabyrinthine) approach to revascularize the PCA. We describe operative nuances for safe and reliable revascularization procedure to them. Methods: We reviewed retrospectively clinical records of the patients received revascularization to the SCA or PCA between April 2010 and December 2013. Results: In this study, five patients received six revascularization procedures, four STA-SCA bypasses, one STA-PCA bypass, and one V3-P2 bypass. Three of four STA-SCA bypasses were done with subtemporal approach and the rest was done by the transpetrosal approach before V3-P2 bypass. Two revascularizations of the PCA were performed by the transpetrosal approach. All surgeries were done without any additional complications and all grafts kept patency. Conclusion: In revascularization of the SCA, subtemporal approach is appropriate if enough care is paid to the vein of Labbe and the subtemporal bridging veins. In revascularization of the PCA, further upward trajectory is necessary. Minimum transpetrosal approach can provide wide field with least temporal lobe retraction.