Oper Neurosurg (Hagerstown). 2017 Jun 1;13(3):E8-E12. doi: 10.1093/ons/opx002.
Aneurysms affecting double origin (DO) posterior inferior cerebellar artery (PICA) variants are rare. Most reports describe endovascular occlusion of the affected branch to treat the aneurysm, but we describe a patient in which open surgical sacrifice of 1 branch resulted in insufficient perfusion.
We report the only case of open surgical treatment of an aneurysm affecting a leg of a DOPICA. A 42-year-old woman presenting with the worst headache of her life was found to have a DOPICA aneurysm and initially treated by trapping the aneurysm. Intraoperative indocyanine green imaging revealed insufficient perfusion through the caudal branch, which was remediated by end-to-end anastomosis to preserve flow through both origins. The patient made a full recovery.
Treating a DOPICA aneurysm by sacrificing 1 of the origins is not possible for all patients. This first report of open surgical treatment of a DOPICA leg aneurysm suggests that 1 or both branches may be required for sufficient perfusion, and the unique embryology of DOPICA development suggests a possible mechanism.
影响双起源（DO）后下小脑动脉（PICA）变体的动脉瘤很少见。大多数报道描述了通过血管内闭塞受累分支来治疗动脉瘤，但我们描述了一例患者，开放手术牺牲 1 个分支导致灌注不足。
我们报告了首例影响 DOPICA 分支的动脉瘤的开放手术治疗。一名 42 岁女性因一生中最严重的头痛就诊，发现患有 DOPICA 动脉瘤，最初通过夹闭动脉瘤进行治疗。术中吲哚菁绿成像显示通过尾部分支的灌注不足，通过端对端吻合修复以保持两个起源的血流。患者完全康复。
对于所有患者来说，通过牺牲其中一个起源来治疗 DOPICA 动脉瘤是不可能的。首例 DOPICA 分支动脉瘤的开放手术治疗报告表明，对于充分灌注，可能需要 1 个或 2 个分支，而 DOPICA 发育的独特胚胎学表明可能存在某种机制。
