Kakino Shunsuke, Ogasawara Kuniaki, Kubo Yoshitaka, Otawara Yasunari, Tomizuka Nobuhiko, Suzuki Michiyasu, Ogawa Akira
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Surg Neurol. 2004 Feb;61(2):185-9; discussion 189. doi: 10.1016/j.surneu.2003.06.001.
In patients with aneurysms that involve the origin of the posterior inferior cerebellar artery (PICA) and require occlusion of the vertebral artery (VA), revascularization of the PICA is commonly performed. We present six patients with dissecting VA aneurysms who underwent PICA-PICA anastomosis combined with parent artery occlusion.
After a lower lateral suboccipital craniectomy and partial resection of the jugular tubercle, anastomoses were performed in a side-to-side fashion at the posterior medullary segment of the PICA. The VA was subsequently occluded by clipping proximal and distal to the aneurysm, and the PICA was occluded by clipping distal to the aneurysm.
Postoperative cerebral angiography demonstrated patency of the anastomosis and regression of the aneurysm in five of six patients. The remaining patient experienced hemorrhage from contralateral VA dissection and subsequently died. One patient experienced myopathy of the lower extremities secondary to intraoperative fixed board compression and developed permanent lower extremity muscular weakness. The remaining four cases experienced no new neurologic deficits.
PICA-PICA anastomosis is a useful procedure for reconstruction of the PICA when parent vessel occlusion or trapping is necessary to exclude a VA aneurysm involving the origin of the PICA.
对于累及小脑后下动脉（PICA）起始部且需要闭塞椎动脉（VA）的动脉瘤患者，通常会进行PICA血运重建。我们报告6例患有椎动脉夹层动脉瘤的患者，他们接受了PICA - PICA吻合术并联合闭塞载瘤动脉。
在进行枕下外侧低位颅骨切除术和部分切除颈静脉结节后，于PICA延髓后段以端 - 端方式进行吻合。随后通过在动脉瘤近端和远端夹闭来闭塞VA，并通过在动脉瘤远端夹闭来闭塞PICA。
术后脑血管造影显示6例患者中有5例吻合口通畅且动脉瘤缩小。其余1例患者因对侧椎动脉夹层出血，随后死亡。1例患者因术中固定板压迫继发下肢肌病，出现永久性下肢肌肉无力。其余4例未出现新的神经功能缺损。
当需要闭塞或包裹载瘤血管以排除累及PICA起始部的VA动脉瘤时，PICA - PICA吻合术是重建PICA的一种有效方法。
