Hamada Jun-ichiro, Todaka Tatemi, Yano Shigetoshi, Kai Yutaka, Morioka Motohiro, Ushio Yukitaka
Department of Neurosurgery, Kumamoto University School of Medicine, Japan.
J Neurosurg. 2002 May;96(5):867-71. doi: 10.3171/jns.2002.96.5.0867.
In patients with aneurysms that require occlusion of the posterior inferior cerebellar artery (PICA), revascularization of this artery should be performed. A novel surgical method for revascularization of the PICA is presented.
After a segment of the superficial temporal artery (STA) was harvested, the aneurysm was treated by trapping, followed by placement of a vertebral artery (VA)-PICA bypass in which the STA segment was used as a graft. When the length of the proximal PICA was inadequate, the distal end of the STA was anastomosed to the proximal PICA in an end-to-side fashion. When the length of the proximal PICA was adequate, the STA was anastomosed to the proximal PICA in an end-to-end fashion. In either case, the proximal end of the STA was anastomosed to the VA in an end-to-side fashion. This procedure was used in nine patients whose aneurysms involved the PICA. Although partial lateral medullary syndrome developed in one of them, follow-up evaluation revealed graft patency in all patients. There were no instances of recurrent hemorrhage or ischemia.
Although this procedure requires harvesting of an STA graft and two anastomoses, it facilitates anterograde flow to the PICA territory. It also involves minimal mobilization of brainstem perforating vessels and the proximal PICA.
对于需要闭塞小脑后下动脉（PICA）的动脉瘤患者，应进行该动脉的血管重建。本文介绍一种新型的PICA血管重建手术方法。
切取一段颞浅动脉（STA）后，采用包裹法治疗动脉瘤，随后进行椎动脉（VA）-PICA搭桥术，将切取的STA段用作移植物。当近端PICA长度不足时，将STA远端以端侧方式吻合至近端PICA。当近端PICA长度足够时，将STA以端端方式吻合至近端PICA。无论哪种情况，STA近端均以端侧方式吻合至VA。该手术应用于9例动脉瘤累及PICA的患者。尽管其中1例出现了部分延髓外侧综合征，但随访评估显示所有患者的移植物均通畅。无复发出血或缺血病例。
尽管该手术需要切取STA移植物并进行两次吻合，但它有助于向PICA区域的顺行血流。它还涉及脑干穿支血管和近端PICA的最小限度游离。
