Vertebral Artery-Posterior Inferior Cerebellar Artery (PICA) Bypass Using a Superficial Temporal Artery Graft to Treat the Ruptured Dissecting Aneurysms Involving the PICA

Abstract

In patients with ruptured dissecting aneurysms requiring occlusion of the posterior inferior cerebellar artery (PICA), revascularization of this artery should be performed. We present a novel technique for revascularization of the PICA.
After a segment of the superficial temporal artery (STA) was harvested, the aneurysm was treated by trapping followed by placement of a vertebral artery-PICA bypass using the STA as an interposed graft. When the length of the proximal PICA was inadequate, the distal end of the STA was anastomosed to the proximal PICA in an end-to-side fashion. When the length of the proximal PICA was adequate, the STA was anastomosed to the proximal PICA in an end-to-end fashion. In either case, the proximal end of the STA was anastomosed to the vertebral artery in an end-to-side fashion. This procedure was used in 7 patients whose dissecting aneurysms involved the PICA. Although 1 patient developed partial laterally medullary syndrome, follow-up evaluation revealed graft patency in all patients.
Although our procedure requires harvesting of a STA graft and 2 anastomoses, it facilitates anterograde flow to the PICA territory. It also involves minimal mobilization of brain stem perforators and the proximal PICA.