2021 年 49 巻 5 号 p. 401-407
We report two cases of ruptured dissecting aneurysms of the vertebral artery (VA) involving the origin of the posterior inferior cerebellar artery (PICA), which were successfully managed thorugh proximal occlusion (PO) of the VA and PICA along with reconstruction of the PICA. Case 1: A 43-year-old male presented with subarachnoid hemorrhage (SAH) that was caused by a PICA-involved type of VA dissection. A PO along with the reconstruction of the PICA was performed because a massive and hard hematoma involving the lower cranial nerves (LCN) prevented the distal end of the dissection from being secured safely. Case 2: A 54-year-old male presented with SAH that was caused by a PICA-involved type of VA dissection was operated upon with this method because the anterior spinal artery (ASA) originating at the end of the dissection made it difficult to trap the entire lesion without compromising the ASA. Both patients eventually recovered without ischemic complications or LCN palsy (LCNP). Postoperative computed angiography demonstrated the disappearance of the dissection and good patency of the bypass.
;Although trapping of the entire lesion along with the reconstruction of the PICA is the first line of surgical management for PICA-involved type of VA dissections, high frequency of LCNP, and ischemic complications in the brain stem have been reported. PO with the reconstruction of the PICA is an effective alternative in cases with a high risk of LCNP or ischemic complications.
