PDF(Pubmed)
Abstract：
Vertebral artery （VA）Aneurysms involving the origin of the posterior inferior cerebellar artery (PICA) ,occasionally, induce cerebellum and brainstem infarction due to intraluminal thrombus and calcific VA stenosis. At times, vessel occlusion and revascularization is necessary for successful obliteration of these aneurysms.2 The occipital artery (OA) is often the preferred donor graft for lesions of the posterior fossa. Although most OA-PICA bypasses can be performed using the p3 segment as the recipient site for an end-to-side anastomosis, a more feasible alternative to conventional OA-p3 PICA bypass in cases of high-riding caudal loops , aberrant anatomy or p3 multiple perforators is to free the p1 PICA, transpose it away from the lower cranial nerves, and perform an end-to-end OA-p1 PICA bypass instead. This video captures the dissection of the OA using an orientational anterograde harvesting technique and the end-to-end anastomosis of the OA to the PICA at the p1 segment. This was performed in a 56-year-old man who presented with posterior circulation ischemia from a fusiform aneurysm with calcific vertebral artery stenosis located at the origin of the right PICA. The patient tolerated the procedure well and suffered no major complications related to the operation. He did experience some mild, posterior neck rigidity at the time of his 6-month follow-up, likely due to nerve injury that occurred while harvesting the OA. Overall, the patient remains in good neurologic status 1 year after the operation. The operation proved the feasibility of end-to-end bypass in OA-p1 PICA.
摘要：
椎动脉（VA）累及小脑后下动脉（PICA）起源的动脉瘤,偶尔,由于腔内血栓和钙化性VA狭窄而引起小脑和脑干梗塞。有时,血管闭塞和血运重建是成功闭塞这些动脉瘤的必要条件。2枕动脉（OA）通常是后颅窝病变的首选供体移植物。尽管大多数OA-PICA旁路可以使用p3段作为端侧吻合的受体部位进行，在高骑尾环的情况下，更可行的替代常规OA-p3PICA旁路，异常解剖或p3多个穿孔器是为了释放p1PICA，把它从下颅神经转移出去，并执行端到端OA-p1PICA旁路。该视频使用定向顺行收获技术捕获了OA的解剖，并在p1段将OA与PICA进行了端到端吻合。这是在一名56岁的男子中进行的，该男子因位于右PICA起点的纺锤状动脉瘤伴钙化性椎动脉狭窄而出现后循环缺血。患者对手术的耐受性良好，没有与手术相关的重大并发症。他确实经历了一些温和的，在他6个月的随访时，后颈部僵硬，可能是由于采集OA时发生的神经损伤。总的来说,术后1年,患者仍保持良好的神经系统状态.该操作证明了在OA-p1PICA中端到端旁路的可行性。
