Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):471-7. doi: 10.1227/NEU.0b013e3181f7420e.
An intracranial posterior circulation revascularization procedure in the form of a side-to-side in situ posterior inferior cerebellar artery (PICA)-PICA bypass operation was introduced in 1991. This elegant and apparently low-risk operation is performed infrequently. Thus, the operative nuances used in this procedure have not been well reported, limiting the scope of treatment modalities of vertebral artery-PICA aneurysms and vertebral dissections.
To repair an incidental right-sided PICA aneurysm noted in a 51-year-old woman in magnetic resonance imaging and subsequent angiography.
The patient underwent side-to-side in situ PICA-PICA bypass surgery.
Immediate indocyanine green angiography suggested that the PICA distal to the aneurysms was filling in a retrograde fashion through the bypass. On the following day, the patient was taken for coil embolization of the aneurysm. However, angiography images revealed that the aneurysm was spontaneously thrombosed, the proximal PICA was patent, and the PICA distal to the aneurysms was filling in a retrograde fashion, as suspected in intraoperative indocyanine green angiography. No further treatments were done. The patient recovered fully.
We describe in detail the preoperative evaluation, decision process, and operative techniques for a side-to-side in situ PICA-PICA bypass operation, which is a relatively safe and elegant posterior circulation bypass procedure.
1991 年引入了一种颅内侧循环再血管化手术形式，即旁正中后下小脑动脉（PICA）-PICA 旁路手术。这种优雅且风险似乎较低的手术并不常见。因此，该手术中使用的手术细节尚未得到很好的报道，限制了椎动脉-PICA 动脉瘤和椎动脉夹层的治疗方式的范围。
修复一名 51 岁女性磁共振成像和随后的血管造影中偶然发现的右侧 PICA 动脉瘤。
患者接受了旁正中原位 PICA-PICA 旁路手术。
即时吲哚菁绿血管造影提示，通过旁路，动脉瘤远端的 PICA 呈逆行方式充盈。第二天，患者接受了动脉瘤的线圈栓塞。然而，血管造影图像显示动脉瘤自发血栓形成，近端 PICA 通畅，动脉瘤远端的 PICA 呈逆行方式充盈，正如术中吲哚菁绿血管造影所怀疑的那样。未进行进一步治疗。患者完全康复。
我们详细描述了旁正中原位 PICA-PICA 旁路手术的术前评估、决策过程和手术技术，这是一种相对安全且优雅的后循环旁路手术。
