Preoperative Considerations in Occipital Artery-high-riding Posterior Inferior Cerebellar Artery Bypass: A Report of Two Cases and a Literature Review

Abstract

Nonsaccular vertebral artery aneurysms involving the posterior inferior cerebellar artery (PICA) are rare. Treatment is considered a significant challenge because of their angiographic and anatomical features, especially in high-riding PICA. Therefore, meticulous preoperative angiographic and anatomical evaluation is necessary. Moreover, consideration of the distance between the cerebellar skull base and caudal loop of the PICA is important. We present two cases of occipital artery-high-riding PICA bypass and discuss important preoperative technical considerations.

Keywords

bypass - occipital artery - posterior inferior cerebellar artery - nonsaccular aneurysm

• References

• 1 Ali MJ, Bendok BR, Tawk RG, Getch CC, Batjer HH. Trapping and revascularization for a dissecting aneurysm of the proximal posteroinferior cerebellar artery: technical case report and review of the literature. Neurosurgery 2002; 51 (01) 258-262 ; discussion 262–263
• 2 Ausman JI, Diaz FG, Vacca DF, Sadasivan B. Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for vertebrobasilar insufficiency. J Neurosurg 1990; 72 (04) 554-558
• 3 Benes L, Kappus C, Sure U, Bertalanffy H. Treatment of a partially thrombosed giant aneurysm of the vertebral artery by aneurysm trapping and direct vertebral artery-posterior inferior cerebellar artery end-to-end anastomosis: technical case report. Neurosurgery 2006; 59 (01) (Suppl. 01) E166-E167 ; discussion E166–E167
• 4 Kawashima M, Rhoton Jr AL, Tanriover N, Ulm AJ, Yasuda A, Fujii K. Microsurgical anatomy of cerebral revascularization. Part II: posterior circulation. J Neurosurg 2005; 102 (01) 132-147
• 5 Fukuda H, Evins AI, Iwasaki K. , et al. The role of alternative anastomosis sites in occipital artery-posterior inferior cerebellar artery bypass in the absence of the caudal loop using the far-lateral approach. J Neurosurg 2017; 126 (02) 634-644
• 6 Sekhar LN, Kalavakonda C. Cerebral revascularization for aneurysms and tumors. Neurosurgery 2002; 50 (02) 321-331
• 7 Khodadad G, Singh RS, Olinger CP. Possible prevention of brain stem stroke by microvascular anastomosis in the vertebrobasilar system. Stroke 1977; 8 (03) 316-321
• 8 Sundt Jr TM, Piepgras DG. Occipital to posterior inferior cerebellar artery bypass surgery. J Neurosurg 1978; 48 (06) 916-928
• 9 Macchi V, Porzionato A, Parenti A, De Caro R. The course of the posterior inferior cerebellar artery may be related to its level of origin. Surg Radiol Anat 2004; 26 (01) 60-65
• 10 Ateş O, Ahmed AS, Niemann D, Başkaya MK. The occipital artery for posterior circulation bypass: microsurgical anatomy. Neurosurg Focus 2008; 24 (02) E9
• 11 Narducci A, Xu R, Vajkoczy P. Decision making in surgery for nonsaccular posterior inferior cerebellar artery aneurysms with special reference to intraoperative assessment of collateral blood flow and neurophysiological function. Oper Neurosurg (Hagerstown) 2018; 14 (04) 422-431