Abstract
Vertebro-basilar insufficiency frequently occurs because of stenosis in the proximal of the basilar artery and the first portion of the extracranial vertebral artery.
In this report, two methods of surgical management of vertebro-basilar occlusive disease are described. First, the technique of interposition venous graft bypass from the external carotid to the superior cerebellar artery for ischemia of the rostral brain stem is described.
Venous graft might be considered as a successful substitute for the STA if the STA is not sufficiently long and large. But in this operation, care must be taken to prevent torsion and kinking of the graft and external compression at the subcutaneous site. Therefore we devised double subcutaneous tunnel method. In this technique, a little bit larger size in diameter of artificial vessel is passed subcutaneously from the cervical region to the craniotomized scalp site. Then the vein graft is passed through in the artificial vessel.
The second method of treatment is extracranial vertebral artery reconstruction.
Though a vertebral artery endarterectomy is a technique that has been much described in reports, the disadvantage of this procedure is that often a sternotomy or the cutting of the clavicle is necessary to expose the extensive operating field.
Since the surgical intervention is relatively minor, many cases of successful transposition of the VA to the SA have been reported. But in certain cases, the VA may not be long enough to transpose to the SA. Therefore, to avoid this problem, we have used a short vein bypass between the VA and SA. We have found that transpositions of the vertebral artery to the SA or a short vein bypass are safe and relatively easy technique.
