2019 年 47 巻 4 号 p. 255-259
The occipital artery-posterior inferior cerebellar artery (OA-PICA) bypass is a well-known surgical technique for the treatment of vertebral artery (VA) aneurysms involving the PICA. However, the OA-PICA bypass is considered to be a difficult procedure owing to the deep operative field and the proximity of the lower cranial nerves. The mid-lateral suboccipital approach allows for the establishment of a wide and superficial operative field reliably and safely.
We performed OA-PICA bypasses for five cases that included dissecting VA aneurysms (two cases), a large VA aneurysm (one case), a PICA dissecting aneurysm (one case), and a VA-PICA aneurysm (one case).
The patients were placed in the prone position. J-shaped skin incisions were made, and osteoplastic craniotomies were advanced to the condyle fossa, which provided wide and superficial operative views. Trapping/clipping and OA-PICA bypass were performed in all the five cases. The most critical step in the bypass was the intimal check before pulling out the needle.
In our technique, the wide and superficial operative field enabled us to safely perform the clipping and OA-PICA bypass.