Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.
Depart-ment of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Oper Neurosurg (Hagerstown). 2017 Jun 1;13(3):309-316. doi: 10.1093/ons/opw033.
Posterior cerebral artery (PCA) aneurysms are rare and the majority are fusiform in shape. Proximal occlusion of PCA represents a treatment option for these lesions. However, this procedure carries a high risk of ischemic complications.
To describe the technique of trapping a fusiform PCA aneurysm and revascularization of the distal PCA using a superficial temporal artery (STA) graft through the same microsurgical approach.
From September 2012 to October 2014, we retrospectively identified 3 patients harboring a fusiform PCA aneurysm (P2 segment aneurysm) who underwent trapping of the aneurysm and reconstruction of the distal PCA through the same subtemporal approach. We analyzed immediate morbidity, surgical complications, and the patency of the bypass to determine the feasibility of this procedure.
All 3 patients underwent successful trapping of the fusiform PCA aneurysm and revascularization of the distal PCA. The origin of P3 segment or posterior temporal artery (PTA) served as recipient arteries. In all 3 cases, adequate blood flow was evident after performing the STA-P3/PTA bypass. None of the patients experienced a new permanent neurological deficit. At 1-year follow-up, the STA-PTA/PCA bypasses remained patent.
The STA-P3/PTA bypass through the subtemporal approach is a feasible option to maintain blood flow in cases of PCA fusiform aneurysms requiring trapping of the P2 segment.
大脑后动脉（PCA）动脉瘤较为罕见，大多数呈梭形。近端 PCA 闭塞是治疗这些病变的一种选择，但该手术有较高的缺血性并发症风险。
描述通过颞浅动脉（STA）桥接在同一显微手术入路中夹闭梭形 PCA 动脉瘤和重建 PCA 远端的技术。
从 2012 年 9 月至 2014 年 10 月，我们回顾性分析了 3 例存在 PCA 梭形动脉瘤（P2 段动脉瘤）的患者，他们接受了通过同一颞下入路夹闭动脉瘤和重建 PCA 远端的治疗。我们分析了即刻发病率、手术并发症以及旁路的通畅性，以确定该手术的可行性。
所有 3 例患者均成功夹闭了 PCA 梭形动脉瘤并重建了 PCA 远端。P3 段或颞后动脉（PTA）的起源作为受体动脉。在所有 3 例患者中，STA-P3/PTA 旁路完成后均可见到充足的血流。没有患者出现新的永久性神经功能缺损。在 1 年的随访中，STA-PTA/PCA 旁路仍然通畅。
通过颞下入路的 STA-P3/PTA 旁路是一种可行的选择，可在需要夹闭 P2 段的 PCA 梭形动脉瘤的情况下维持血流。
