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Vertebral Artery to Vertebral Artery Bypass with Interposed Radial Artery or Occipital Artery Grafts Surgical Technique and Report of 3 Cases

Vertebral Artery to Vertebral Artery Bypass with Interposed Radial Artery or Occipital Artery Grafts Surgical Technique and Report of 3 Cases

The treatment of unclippable vertebral artery (VA) aneurysms incorporating the posterior inferior cerebellar artery with parent artery preservation is among one of the most formidable challenges for cerebrovascular microsurgery and endovascular surgery. We propose that intracranial VA reconstruction using an extracranial VA-to-intracranial VA (VA-VA) bypass with a radial artery graft (RAG) or an occipital artery (OA) graft may be an additional technique in the armamentarium to treat these formidable lesions. The rationale, surgical technique, and complications are discussed. Three illustrative cases are described, in which the lesions were a VA dissecting aneurysm with ischemic lesions, bilateral asymptomatic unruptured VA aneurysms, and a VA giant aneurysm with subarachnoid hemorrhage. The partial extreme lateral infrajugular transcondylar approach was utilized. Computerized tomographic angiography was useful for preoperative evaluation of the depth of the distal aneurysmal neck. A VA-VA bypass was performed in 2 patients. Because there was another ipsilateral aneurysm at the V2 segment in 1 patient, an external carotid artery-VA bypass was performed. Although 2 patients were discharged with good clinical results, 1 patient with subarachnoid hemorrhage died due to brain stem infarction. The VA-VA bypass using a RAG or an OA graft is an option that can be considered in the treatment strategy for treating VA aneurysms to preserve the normal anatomical vascular configuration in the posterior circulation.

Accession: 036712443

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