Abashiri Neurolosurgical-Rehabilitation Hospital, 4-1-7 Katsuramachi, Abashiri, Hokkaido 093-0041, Japan.
Acta Neurochir (Wien). 2013 Aug;155(8):1517-24; discussion 1524. doi: 10.1007/s00701-013-1715-z. Epub 2013 May 7.
Symptomatic fusiform intracranial vertebral artery aneurysms pose a formidable treatment challenge when not amenable to endovascular treatment. In this paper, we illustrate the microsurgical management of such an aneurysm.
To prevent neurological deterioration, anatomical reconstruction preserving all vessels including posterior inferior cerebellar artery and perforators is essential. In this case illustration, the occipital artery was used as a donor to a perforator originating from the aneurysmal segment. This bypass was performed in an end-to-side fashion. Subsequently, the aneurysmal component of the vertebral artery was resected and an end-to-side (V4 to V3) bypass was performed using a radial artery graft.
The patient achieved complete resection of the aneurysm preserving normal anatomy of the posterior circulation without any ischemic complications.
Complex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy.
当梭形颅内椎动脉动脉瘤不适合血管内治疗时，其治疗极具挑战性。本文介绍了此类动脉瘤的显微外科治疗方法。
为了防止神经功能恶化，解剖重建至关重要，需要保留所有血管，包括小脑后下动脉及其穿支。在本病例中，枕动脉被用作来自动脉瘤段的穿支的供体。该旁路以端侧吻合方式进行。随后，切除椎动脉的动脉瘤部分，并使用桡动脉移植物进行端侧吻合（V4 至 V3）。
患者实现了动脉瘤的完全切除，同时保留了后循环的正常解剖结构，没有任何缺血性并发症。
对于复杂的血管病变，不能进行血管内治疗，复杂的脑动脉旁路技术是脑血管治疗中不可或缺的手段。
